Provider Demographics
NPI:1407991870
Name:WELLS, EDYTHE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:EDYTHE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 W FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-8738
Mailing Address - Country:US
Mailing Address - Phone:608-362-6464
Mailing Address - Fax:775-587-2178
Practice Address - Street 1:2939 W FINLEY RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-8738
Practice Address - Country:US
Practice Address - Phone:608-362-6464
Practice Address - Fax:775-587-2178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18 - 49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife