Provider Demographics
NPI:1760013312
Name:WELLS, REBECCA LEA (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEA
Last Name:WELLS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LEA
Other - Last Name:WELLS-STOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:736 IRVING AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1690
Mailing Address - Country:US
Mailing Address - Phone:315-470-7111
Mailing Address - Fax:
Practice Address - Street 1:CROUSE HOSPITAL
Practice Address - Street 2:736 IRVING AVE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1690
Practice Address - Country:US
Practice Address - Phone:315-470-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF431656-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care