| Doctor Name: | MS. SANDRA ANN WELLS |
| NPI Number: | 1154485498 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN RN CNS |
| License Number: | 0001104385 |
| Business Practice Address: | 5999 Burke Commons Rd 3rd Floor Burke, VA - 220152880 |
| Business Phone Number: | 7032497219 |
| Business Fax Number: | 7032497250 |
| Mailing Address: | 2101 E Jefferson St, Kaiser Permanente Medicare Enrollment ROCKVILLE |
| State: | MD |
| Postal Code: | 208524908 |
| Phone Number: | 3018162424 |
| Fax Number: | 3018166308 |
| NPI Enumeration Date: | 12/21/2006 |
| NPI Last Update Date: | 12/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 0001104385 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |