Provider Demographics
NPI:1144021619
Name:WELLS, RAQUEL AMANDA (APRN)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:AMANDA
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FLUME ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5428
Mailing Address - Country:US
Mailing Address - Phone:707-900-8833
Mailing Address - Fax:
Practice Address - Street 1:329 FLUME ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5428
Practice Address - Country:US
Practice Address - Phone:707-900-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034447363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care