1699144303 NPI number — MS. CHRISTINA LYNN WELLS FNP

Table of content: MS. CHRISTINA LYNN WELLS FNP (NPI 1699144303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699144303 NPI number — MS. CHRISTINA LYNN WELLS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLS
Provider First Name:
CHRISTINA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699144303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7412011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-362-7216
Provider Business Mailing Address Fax Number:
314-696-1391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1418 CROSS ST
Provider Second Line Business Practice Location Address:
DIV WUPI HEMATOLOGY, STE 180
Provider Business Practice Location Address City Name:
SHILOH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-7216
Provider Business Practice Location Address Fax Number:
314-696-1391
Provider Enumeration Date:
09/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209023830 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 420155582 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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