Provider Demographics
NPI:1942448477
Name:WELLS, JILL (LMT,BS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMT,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 NW SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9126
Mailing Address - Country:US
Mailing Address - Phone:541-974-4790
Mailing Address - Fax:
Practice Address - Street 1:5020 NW SPRINGHILL DR
Practice Address - Street 2:341 2ND AVE. S.E.
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-9126
Practice Address - Country:US
Practice Address - Phone:541-974-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist