Provider Demographics
NPI:1124013362
Name:WELLER, D-ANN MARIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:D-ANN
Middle Name:MARIE
Last Name:WELLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:D-ANN
Other - Middle Name:WELLER
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10123 E ISLETA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7775
Mailing Address - Country:US
Mailing Address - Phone:240-299-5308
Mailing Address - Fax:
Practice Address - Street 1:2145 E BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1546
Practice Address - Country:US
Practice Address - Phone:240-299-5308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015070363L00000X
WAAP30006785363LF0000X
FLARNP9371233363LF0000X
AZAP11586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ24260Medicare UPIN