Provider Demographics
NPI:1821509183
Name:WELLS, TIFFANY EILEEN (NP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:EILEEN
Last Name:WELLS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SAINT JOHNS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2436
Mailing Address - Country:US
Mailing Address - Phone:208-750-7462
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2434
Practice Address - Country:US
Practice Address - Phone:208-750-7507
Practice Address - Fax:208-750-7384
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily