Individual
CARLOS JOHN WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
9 UNION STREET, ROOSEVELT, NY 11575
(516) 379-2138
Mailing address
167-19 142 AVE, JAMAICA, NY 11434
(718) 316-7945
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
267953
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02415024
—
NY
Enumeration date
06/05/2007
Last updated
07/08/2007
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