| Doctor Name: | MR. MARK WELLS |
| NPI Number: | 1497905061 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | SP009967 |
| Business Practice Address: | 1907 Lebanon Church Rd West Mifflin, PA - 151222432 |
| Business Phone Number: | 4125617246 |
| Business Fax Number: | 4122354012 |
| Mailing Address: | Po Box 747, GREENSBURG |
| State: | PA |
| Postal Code: | 156010747 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/19/2008 |
| NPI Last Update Date: | 09/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP009967 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |