Provider Demographics
NPI:1417736612
Name:WELLS, COURTNEY III
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WELLS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1222
Mailing Address - Country:US
Mailing Address - Phone:513-908-0858
Mailing Address - Fax:
Practice Address - Street 1:1757 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1222
Practice Address - Country:US
Practice Address - Phone:513-908-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion