Provider Demographics
NPI:1376813386
Name:WELLS, TAMARA (BA, ECSE)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:BA, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14618 TYLER FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9316
Mailing Address - Country:US
Mailing Address - Phone:530-292-3648
Mailing Address - Fax:
Practice Address - Street 1:113 PRESLEY WAY STE 9
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5847
Practice Address - Country:US
Practice Address - Phone:530-264-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140173521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist