MEDICARE: MAURCENA WELLS R.N.F.A

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	163WR0006X	Registered Nurse First Assistant	R07574	NM

General Provider Information

NPI Number	:	1598838492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURCENA WELLS R.N.F.A

Provider Business Mailing Address
First Line	:	3006 INDIANA ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-872-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 INDIANA ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2627
Country	:	US
Telephone Number	:	505-872-4002
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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