Provider Demographics
NPI:1194969832
Name:WELLS, DIANE KEEGAN (RN, CPNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KEEGAN
Last Name:WELLS
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:22 S GREENE ST
Mailing Address - Street 2:ROOM N5E16
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-2808
Mailing Address - Fax:410-328-0571
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:ROOM N5E16
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2808
Practice Address - Fax:410-328-0571
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR091240363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics