Individual
BECKY J WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
260 S TEN MILE RD, MERIDIAN, ID 83642-6100
(208) 809-2872
(208) 809-2873
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-839
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808592100
—
ID
Enumeration date
07/09/2006
Last updated
03/26/2019
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