Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP03587 | OH |
NPI | 1053330605 |
---|---|
Provider Name | Mrs. Beverly A Wells |
First Address | Kettering, OH 45429-2706 |
Second Address | Cincinnati, OH 45219-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2368441 | (05) | OH |