Provider Demographics
NPI:1629576152
Name:WELLS, DINA MARIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SE MACY RD STE 18
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7844
Mailing Address - Country:US
Mailing Address - Phone:479-845-0880
Mailing Address - Fax:479-286-0061
Practice Address - Street 1:3400 SE MACY RD STE 18
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7844
Practice Address - Country:US
Practice Address - Phone:479-845-0880
Practice Address - Fax:479-286-0061
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA005113OtherCNP
ARR036076OtherRN