Provider Demographics
NPI:1679362438
Name:WELLS, ALISHA JANE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:JANE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 11TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162
Mailing Address - Country:US
Mailing Address - Phone:308-562-7947
Mailing Address - Fax:
Practice Address - Street 1:2476 11TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2333
Practice Address - Country:US
Practice Address - Phone:308-562-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01998110903Medicaid