MEDICARE: BARBARA A. WELLS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN169067-L	PA

General Provider Information

NPI Number	:	1609824671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA A. WELLS CRNA

Provider Business Mailing Address
First Line	:	2884 ROBERT OLIVER AVE
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-6300
Country	:	US
Telephone Number	:	904-491-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 PARK ST
Second Line	:	#240
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7607
Country	:	US
Telephone Number	:	904-389-1077
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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