Provider Demographics
NPI:1669405809
Name:WELLS, DAWNA L (PA-C)
Entity type:Individual
Prefix:
First Name:DAWNA
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30976
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-0976
Mailing Address - Country:US
Mailing Address - Phone:406-238-6290
Mailing Address - Fax:406-238-6961
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:STE 160W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6290
Practice Address - Fax:406-238-6961
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT77363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
972121040206OtherPREFERRED ONE
MTP00406980OtherRAILROAD MEDICARE MT
MT1669405809Medicaid
MT000900293OtherBLUE CROSS
MT1669405809Medicaid
972121040206OtherPREFERRED ONE