Provider Demographics
NPI:1295075422
Name:WELLS, CATHY LEE (RN)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:LEE
Last Name:WELLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:LEE
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14905 W AVON NORTH TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-8902
Mailing Address - Country:US
Mailing Address - Phone:608-897-6162
Mailing Address - Fax:
Practice Address - Street 1:14905 W AVON NORTH TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-8902
Practice Address - Country:US
Practice Address - Phone:608-897-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170137-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI$$$$$$$$$AOtherMEDICARE