Provider Demographics
NPI:1275930984
Name:WELLS, COLLEEN MARGARET
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARGARET
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARGARET
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:901 NE INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5544
Mailing Address - Country:US
Mailing Address - Phone:816-246-8000
Mailing Address - Fax:816-555-4263
Practice Address - Street 1:1515 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5849
Practice Address - Country:US
Practice Address - Phone:816-347-3204
Practice Address - Fax:816-554-4263
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062350163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health