Provider Demographics
NPI:1417214222
Name:WELLS, KALANI RAQUEL (APN)
Entity type:Individual
Prefix:MISS
First Name:KALANI
Middle Name:RAQUEL
Last Name:WELLS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:STE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:708-361-0222
Practice Address - Fax:708-361-4536
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209009509363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care