Provider Demographics
NPI:1114224847
Name:WELLS, MARYANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12471 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4217
Mailing Address - Country:US
Mailing Address - Phone:909-797-0230
Mailing Address - Fax:
Practice Address - Street 1:12471 BIRCH ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4217
Practice Address - Country:US
Practice Address - Phone:909-797-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697325163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care