Individual
MARY CAITLIN WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-5155
(503) 988-5185
Mailing address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-5155
(503) 988-5185
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201502244NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
Enumeration date
04/27/2015
Last updated
06/08/2015
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