Provider Demographics
NPI:1235182783
Name:WELLCARE INC
Entity Type:Organization
Organization Name:WELLCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:401-272-8773
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 243
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-272-8773
Mailing Address - Fax:401-272-8770
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 243
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-272-8773
Practice Address - Fax:401-272-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP184363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWC44529Medicaid
RIS54183Medicare UPIN