Provider Demographics
NPI:1154305258
Name:WELLS, SHELLEY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-602-9833
Mailing Address - Fax:866-993-9501
Practice Address - Street 1:1316 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:515-532-3119
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42287207L00000X
IA4301207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21714OtherSIOUX VALLEY
MN882882OtherARAZ
MN128907Medicaid
MN15D87WEOtherBCBS/MEDICARE SUPPLEMENT
MN20-01845OtherMEDICA
MN522797Medicaid
MN7312OtherAVERA
MNHP36388OtherHEALTH PARTNERS
MN74913300Medicaid
MNMH904102684OtherPPO
MN15D87WEMedicaid
MN15D87WEOtherBCBS
MNA045OtherCHAMPUS
MNHP36388OtherHEALTH PARTNERS
G10206Medicare UPIN
MN50001216Medicare ID - Type UnspecifiedMEDICARE
MN522797Medicaid