Provider Demographics
NPI:1922345776
Name:WELLS, LARRISHA
Entity Type:Individual
Prefix:
First Name:LARRISHA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:
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 910544
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0544
Mailing Address - Country:US
Mailing Address - Phone:859-410-8550
Mailing Address - Fax:859-223-0642
Practice Address - Street 1:1920 NW AMBERGLEN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6980
Practice Address - Country:US
Practice Address - Phone:971-327-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other