Provider Demographics
NPI:1811652878
Name:WELLINGTON, MARY NSE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:NSE
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:NSE
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:25319 INTERSTATE 45 STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3551
Mailing Address - Country:US
Mailing Address - Phone:832-253-4640
Mailing Address - Fax:
Practice Address - Street 1:10310 GOLDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4345
Practice Address - Country:US
Practice Address - Phone:832-253-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058602363LP0808X
TX899277163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice