Provider Demographics
NPI:1780136036
Name:WELLS, SANDRA ADELE (RN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ADELE
Last Name:WELLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 LITTLE WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6202
Mailing Address - Country:US
Mailing Address - Phone:575-956-2121
Mailing Address - Fax:575-956-2134
Practice Address - Street 1:1625 LITTLE WALNUT RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6202
Practice Address - Country:US
Practice Address - Phone:575-956-2121
Practice Address - Fax:575-956-2134
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM375489390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program