Provider Demographics
NPI:1891709978
Name:WELLS, NANCY ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR. SUITE 240
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-742-5800
Mailing Address - Fax:318-741-3902
Practice Address - Street 1:2400 HOSPITAL DR. SUITE 240
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-742-5800
Practice Address - Fax:318-741-3902
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN052090AP03250363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557021Medicaid
LA52090-3250OtherSTATE LICENSE
LA1557021Medicaid
LA52090-3250OtherSTATE LICENSE