Individual
MARY B. WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, LMT, AGNP-C
Contact information
Practice address
11231 DISTINCTIVE DR, ORLAND PARK, IL 60467-9458
(800) 461-9533
Mailing address
11231 DISTINCTIVE DR, ORLAND PARK, IL 60467-9458
(800) 461-9533
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209012826
IL
363LG0600X
Gerontology Nurse Practitioner
209012826
IL
Other
Enumeration date
01/25/2007
Last updated
01/16/2017
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