Provider Demographics
NPI:1417214222
Name:WELLS, KALANI RAQUEL (APN)
Entity Type:Individual
Prefix:MISS
First Name:KALANI
Middle Name:RAQUEL
Last Name:WELLS
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Gender:F
Credentials:APN
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Mailing Address - Street 1:11824 SOUTHWEST HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1055
Mailing Address - Country:US
Mailing Address - Phone:708-361-0222
Mailing Address - Fax:708-361-4536
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:STE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:708-361-0222
Practice Address - Fax:708-361-4536
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209009509363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care