Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71007086A | IN |
NPI | 1003351750 |
---|---|
Provider Name | Betty M Wellman |
First Address | Muncie, IN 47303-4988 |
Second Address | Frankfort, IN 46041-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2017 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001085720 | ANTHEM PROVIDER NUMBER (01) | IN |
300002616 | (05) | IN |