Provider Demographics
NPI:1952473555
Name:WELLS, ANGELIQUE SHANTE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:SHANTE
Last Name:WELLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JESSE HILL JR DRIVE SE
Mailing Address - Street 2:ROOM 402
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-730-1217
Mailing Address - Fax:
Practice Address - Street 1:1920 JOHNS WESLEY AVE
Practice Address - Street 2:COLLEGE PARK REGIONAL HEALTH CENTER
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337
Practice Address - Country:US
Practice Address - Phone:404-765-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138524163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse