Provider Demographics
NPI:1073681144
Name:WELLS, JANE CAMERSON (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CAMERSON
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SOUTH AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8000
Mailing Address - Country:US
Mailing Address - Phone:406-541-6220
Mailing Address - Fax:406-541-6221
Practice Address - Street 1:700 SOUTH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8000
Practice Address - Country:US
Practice Address - Phone:406-541-6220
Practice Address - Fax:406-541-6221
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT96762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT92961OtherBCBS PROVIDER NUMBER