Provider Demographics
NPI:1164041653
Name:WELLS, SHERRELL (LVN)
Entity Type:Individual
Prefix:MS
First Name:SHERRELL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1826
Mailing Address - Country:US
Mailing Address - Phone:310-948-7854
Mailing Address - Fax:
Practice Address - Street 1:5200 SAN GABRIEL PL STE C
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2498
Practice Address - Country:US
Practice Address - Phone:562-222-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709473164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse