Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 00026578 | WA |
Y | 207X00000X | Orthopaedic Surgeon | MD00026578 | WA |
NPI | 1467499301 |
---|---|
Provider Name | Dr. J. Denise Wells |
First Address | Seattle, WA 98148-0133 |
Second Address | Sslt Lake City, UT 84111-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0219667 | STATE L&I (01) | WA |
110964 | (05) | WA |
E80575 | (02) | WA |