Provider Demographics
NPI:1366707960
Name:WELLS HEALTH AND WELLNESS
Entity type:Organization
Organization Name:WELLS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-622-3000
Mailing Address - Street 1:129 S FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-3200
Mailing Address - Country:US
Mailing Address - Phone:336-622-3000
Mailing Address - Fax:336-622-3010
Practice Address - Street 1:129 S FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-3200
Practice Address - Country:US
Practice Address - Phone:336-622-3000
Practice Address - Fax:336-622-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004191261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center