Provider Demographics
NPI:1568646693
Name:WELL, DENISE NONE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:NONE
Last Name:WELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8921 STONEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-9443
Mailing Address - Country:US
Mailing Address - Phone:920-988-1830
Mailing Address - Fax:
Practice Address - Street 1:W8921 STONEY BROOK RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-9443
Practice Address - Country:US
Practice Address - Phone:920-988-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82224-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse