Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 01025176 | IN |
NPI | 1073571600 |
---|---|
Provider Name | Dr. B. Diane Wells |
First Address | Bloomington, IN 47402-1329 |
Second Address | Spencer, IN 47460-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 29/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100195240A | (05) | IN |
C25410 | (02) | IN |