MEDICARE: MS. MELISSA RAE WELLS NP

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	363LW0102X	Women's Health Nurse Practitioner	3294402	FL

General Provider Information

NPI Number	:	1639153505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA RAE WELLS NP

Provider Business Mailing Address
First Line	:	1210 SAINT ANDREWS
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4758
Country	:	US
Telephone Number	:	571-251-3671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 SAINT ANDREWS
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4758
Country	:	US
Telephone Number	:	571-251-3671
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	12/06/2013

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