Provider Demographics
NPI:1376291344
Name:WELLS, JESSICA C
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
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 1:5017 WOLF CREEK PIKE LOT 44
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2444
Mailing Address - Country:US
Mailing Address - Phone:937-993-6785
Mailing Address - Fax:
Practice Address - Street 1:5017 WOLF CREEK PIKE LOT 44
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-2444
Practice Address - Country:US
Practice Address - Phone:937-993-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide