Provider Demographics
NPI:1417574864
Name:WELLS, JENNIFER JEANETTE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANETTE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S CHENANGO ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-6080
Mailing Address - Country:US
Mailing Address - Phone:979-864-9341
Mailing Address - Fax:
Practice Address - Street 1:105 S CHENANGO ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-6080
Practice Address - Country:US
Practice Address - Phone:979-864-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist