Provider Demographics
NPI:1093099525
Name:WELLS, ADONICA BEATRICE (GNP-BC)
Entity Type:Individual
Prefix:
First Name:ADONICA
Middle Name:BEATRICE
Last Name:WELLS
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 W RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4277
Mailing Address - Country:US
Mailing Address - Phone:281-989-2153
Mailing Address - Fax:
Practice Address - Street 1:3511 W RIDGE LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-4277
Practice Address - Country:US
Practice Address - Phone:281-989-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552025363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB148811Medicare UPIN