MEDICARE: MRS. D-ANN MARIE WELLER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3015070	KY
2	363LF0000X	Family Nurse Practitioner	AP30006785	WA
3	363LF0000X	Family Nurse Practitioner	ARNP9371233	FL
4	363L00000X	Nurse Practitioner	AP11586	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124013362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. D-ANN MARIE WELLER CRNP

Provider Business Mailing Address
First Line	:	10123 E ISLETA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-7775
Country	:	US
Telephone Number	:	240-299-5308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 E BASELINE RD STE 104
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1546
Country	:	US
Telephone Number	:	240-299-5308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	01/18/2025

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