Provider Demographics
NPI:1922155795
Name:WELLS, BEVERLY (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-313-2298
Mailing Address - Fax:302-645-3691
Practice Address - Street 1:32060 LONG NECK RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-6228
Practice Address - Country:US
Practice Address - Phone:302-645-3150
Practice Address - Fax:302-645-3159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000358363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039716Medicaid
DEQ46840Medicare UPIN
DE1000039716Medicaid