Provider Demographics
NPI:1740406503
Name:WELLS, JOHN (LVN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3067
Mailing Address - Country:US
Mailing Address - Phone:936-756-8331
Mailing Address - Fax:936-760-2898
Practice Address - Street 1:1020 RIVERWOOD CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2811
Practice Address - Country:US
Practice Address - Phone:936-756-8331
Practice Address - Fax:936-760-2898
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134945164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse