Provider Demographics
NPI:1417436718
Name:WELLS, DONNA DENISE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DENISE
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 1:1280 W GALBRAITH RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5587
Mailing Address - Country:US
Mailing Address - Phone:513-258-8850
Mailing Address - Fax:
Practice Address - Street 1:1280 W GALBRAITHRD APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-258-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321764401115376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272811Medicaid