Provider Demographics
NPI:1962854901
Name:WELLS, DIANA LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4442
Mailing Address - Country:US
Mailing Address - Phone:713-645-6303
Mailing Address - Fax:713-643-2967
Practice Address - Street 1:7428 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4442
Practice Address - Country:US
Practice Address - Phone:713-645-6303
Practice Address - Fax:713-643-2967
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203428164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse