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General NPI Number Information
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NPI Number | 1942286133
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Entity Type | Individual
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Provider Name | JAN ELLEN WELLS ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 109 N FAIRLAND ST SUITE 104
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City | PRYOR
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State | OK
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Zip | 74361-4203
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Country | US
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Telephone | 918-824-4424
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Fax | 918-824-4474
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Provider Business Mailing Address
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Address Line | 109 N FAIRLAND ST SUITE 104
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City | PRYOR
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State | OK
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Zip | 74361-4203
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Country | US
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Telephone | 918-824-4424
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Fax | 918-824-4474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R0027163
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License Number State | OK
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