Provider Demographics
NPI:1487886776
Name:WELLS, ELIZABETH L (NP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1816
Mailing Address - Country:US
Mailing Address - Phone:434-792-1433
Mailing Address - Fax:434-797-2807
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1816
Practice Address - Country:US
Practice Address - Phone:434-792-1433
Practice Address - Fax:434-797-2807
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168402363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487886776Medicaid
VAVAA101560Medicare PIN
VAVVL556AMedicare PIN