Provider Demographics
NPI:1407288905
Name:WELLINGTON, ISATU J (FNP-C)
Entity Type:Individual
Prefix:
First Name:ISATU
Middle Name:J
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 LAS COLINAS BLVD W
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5421
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:1200 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2376
Practice Address - Country:US
Practice Address - Phone:817-429-8300
Practice Address - Fax:817-429-6167
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX751706363LF0000X
TXAP123830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily