Provider Demographics
NPI:1043646276
Name:WELLS, MALINDA ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 ARCH DR
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820
Mailing Address - Country:US
Mailing Address - Phone:419-617-7019
Mailing Address - Fax:
Practice Address - Street 1:359 ARCH DR
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820
Practice Address - Country:US
Practice Address - Phone:419-569-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.152694-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse