Provider Demographics
NPI:1780405407
Name:WELLS, JENIFER (LP60259682)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LP60259682
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1295
Mailing Address - Country:US
Mailing Address - Phone:509-834-0573
Mailing Address - Fax:
Practice Address - Street 1:331 N 1ST ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2303
Practice Address - Country:US
Practice Address - Phone:509-823-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60259682164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse