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NPI Code Detail

MEDICARE: BROOKE WELLS FERNANDEZ

MEDICARE: BROOKE WELLS FERNANDEZ
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
1363LA2200XAdult Health Nurse PractitionerH183569IA
2363LA2200XAdult Health Nurse Practitioner5021742NC
3363LA2200XAdult Health Nurse Practitioner1191646TX
4363LA2200XAdult Health Nurse PractitionerRN10022445MA
5363LA2200XAdult Health Nurse PractitionerSP032330PA
6363LA2200XAdult Health Nurse Practitioner2025002510MO
7363LA2200XAdult Health Nurse Practitioner239843LA
8363LA2200XAdult Health Nurse Practitioner24569SC

General Provider Information

NPI Number : 1265054464
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE WELLS FERNANDEZ
Provider Business Mailing Address
First Line : 1601 GREENE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29208-4001
Country : US
Telephone Number : 803-777-7412
Fax Number :
Provider Business Practice Location Address
First Line : 1601 GREENE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29208-4001
Country : US
Telephone Number :
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2020
Last Update Date : 06/02/2025

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Directions to “ BROOKE WELLS FERNANDEZ ” Practice Location

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