Provider Demographics
NPI:1578556940
Name:WELLS, ANNA M (CSA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:STE 604
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1471
Mailing Address - Country:US
Mailing Address - Phone:859-255-9059
Mailing Address - Fax:859-254-3112
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:STE 604
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-255-9059
Practice Address - Fax:859-254-3112
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY666084OtherANTHEM BCBS
KY000000344089OtherANTHEM BCBS