Provider Demographics
NPI:1982773875
Name:WELLS, DANETTE LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:LEA
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:LEA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9587
Mailing Address - Country:US
Mailing Address - Phone:231-271-5161
Mailing Address - Fax:231-271-3590
Practice Address - Street 1:650 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9587
Practice Address - Country:US
Practice Address - Phone:231-271-5161
Practice Address - Fax:231-271-3590
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP96125Medicare UPIN