Provider Demographics
NPI:1104928381
Name:WELLS, LIZABETH LEAN (APRN,BC)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:LEAN
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 S REX RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:901-763-3636
Mailing Address - Fax:901-255-3636
Practice Address - Street 1:5659 S REX RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3821
Practice Address - Country:US
Practice Address - Phone:901-763-3636
Practice Address - Fax:901-255-3636
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN 139980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36487821Medicare PIN
TNQ38803Medicare UPIN