Provider Demographics
NPI:1215059282
Name:WELLS, MARIE ANTOINETTE (COMPUTER CERTIFICATE)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:WELLS
Suffix:
Gender:F
Credentials:COMPUTER CERTIFICATE
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:ANTOINETTE
Other - Last Name:ACUNA & LOERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COMPUTER CERTIFICATE
Mailing Address - Street 1:14 N COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2585
Mailing Address - Country:US
Mailing Address - Phone:530-666-8630
Mailing Address - Fax:530-666-8637
Practice Address - Street 1:14 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2585
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:530-666-8637
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist