Provider Demographics
NPI:1457656415
Name:WELLS, JANET LYNN
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-0235
Mailing Address - Country:US
Mailing Address - Phone:315-516-1434
Mailing Address - Fax:
Practice Address - Street 1:5589 ONEIDA DR
Practice Address - Street 2:UPPER
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029
Practice Address - Country:US
Practice Address - Phone:315-516-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277773164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse