Provider Demographics
NPI:1225686736
Name:WELLS, ROBIN (STNA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 YOUNG AVE SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3160
Mailing Address - Country:US
Mailing Address - Phone:330-488-4621
Mailing Address - Fax:
Practice Address - Street 1:211 YOUNG AVE SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3160
Practice Address - Country:US
Practice Address - Phone:330-488-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401417460712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide