MEDICARE: MRS. ABIOLA M WELLS LPN

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	164X00000X	Licensed Vocational Nurse	304471	NY

General Provider Information

NPI Number	:	1457655292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABIOLA M WELLS LPN

Provider Business Mailing Address
First Line	:	870 SOUTHERN BLVD APT 7I
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4557
Country	:	US
Telephone Number	:	646-667-5259
Fax Number	:	347-726-3544

Provider Business Practice Location Address
First Line	:	870 SOUTHERN BLVD APT 7I
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4557
Country	:	US
Telephone Number	:	646-667-5259
Fax Number	:	347-726-3544

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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