Provider Demographics
NPI:1033720180
Name:WELLS, DEVANNA S
Entity Type:Individual
Prefix:
First Name:DEVANNA
Middle Name:S
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 KENILWORTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5413
Mailing Address - Country:US
Mailing Address - Phone:330-623-2064
Mailing Address - Fax:
Practice Address - Street 1:384 KENILWORTH AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5413
Practice Address - Country:US
Practice Address - Phone:330-623-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide