Provider Demographics
NPI:1255655106
Name:WELLS, JANA HERTA (LAC)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:HERTA
Last Name:WELLS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MECHLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-5018
Mailing Address - Country:US
Mailing Address - Phone:908-730-7245
Mailing Address - Fax:
Practice Address - Street 1:484 MECHLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:PITTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08867-5018
Practice Address - Country:US
Practice Address - Phone:908-730-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00073900171100000X
PAOM000099171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist