Provider Demographics
NPI:1265252647
Name:WELLS, CHRISTINA MICHELLE (NP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:WELLS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2654
Mailing Address - Country:US
Mailing Address - Phone:970-576-4490
Mailing Address - Fax:
Practice Address - Street 1:1683 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7921
Practice Address - Country:US
Practice Address - Phone:970-400-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN363LF0000X
COAPN.1000180-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily