Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5008767 | NC |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP127294 | TX |
NPI | 1306391776 |
---|---|
Provider Name | Colleen Wells |
First Address | Waxhaw, NC 28173-7068 |
Second Address | Charlotte, NC 28204-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2016 |
Last Update Date | 02/11/2020 |