Provider Demographics
NPI:1083923056
Name:WELLS, GRETCHEN DIANN (FNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:DIANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:DIANN
Other - Last Name:CHAPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:346 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1393
Mailing Address - Country:US
Mailing Address - Phone:785-842-4477
Mailing Address - Fax:785-842-7433
Practice Address - Street 1:346 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1393
Practice Address - Country:US
Practice Address - Phone:785-842-4477
Practice Address - Fax:785-842-7433
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75239-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily