Provider Demographics
NPI:1154485498
Name:WELLS, SANDRA ANN (MSN RN CNS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:MSN RN CNS
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:5999 BURKE COMMONS RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2880
Practice Address - Country:US
Practice Address - Phone:703-249-7219
Practice Address - Fax:703-249-7250
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-06-03
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Provider Licenses
StateLicense IDTaxonomies
VA0001104385163WP0808X
VA0015000672364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88377Medicare UPIN
011542K92Medicare ID - Type Unspecified