Individual
SUSAN J WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2793 LINEVILLE RD, GREEN BAY, WI 54313-7152
(920) 496-4700
(920) 272-1619
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 272-1619
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37177
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32264000
—
WI
Enumeration date
07/18/2006
Last updated
08/27/2008
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