Provider Demographics
NPI:1285709774
Name:WELLS, MARY E (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WELLS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:849 E INDUSTRY ST
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-4301
Mailing Address - Country:US
Mailing Address - Phone:979-540-2122
Mailing Address - Fax:979-540-2120
Practice Address - Street 1:849 E INDUSTRY ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-4301
Practice Address - Country:US
Practice Address - Phone:979-540-2122
Practice Address - Fax:979-540-2120
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX257158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP0165Medicare UPIN