Individual
BRIGHAM TYLER WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3410 ILLINOIS ST, NORTH CHICAGO, IL 60088-3120
(224) 610-3886
Mailing address
10881 SEASONS PL APT 204, PLEASANT PRAIRIE, WI 53158-1340
(385) 223-7433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13826251-1206
UT
Other
Enumeration date
07/22/2024
Last updated
07/31/2024
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