Provider Demographics
NPI:1154483493
Name:WELLS, REBECCA ARAIZA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ARAIZA
Last Name:WELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 FAIRGREENE WAY
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9634
Mailing Address - Country:US
Mailing Address - Phone:301-606-5738
Mailing Address - Fax:
Practice Address - Street 1:300 BALLENGER CENTER DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7096
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022732M72Medicare PIN
MD082NS302Medicare PIN