Provider Demographics
NPI:1497014492
Name:WELLS, REBECCA (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
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 1:2535 US HIGHWAY 50
Mailing Address - Street 2:APARTMENT 41
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9587
Mailing Address - Country:US
Mailing Address - Phone:513-208-4763
Mailing Address - Fax:
Practice Address - Street 1:2535 US HIGHWAY 50
Practice Address - Street 2:APARTMENT 41
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-9587
Practice Address - Country:US
Practice Address - Phone:513-208-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.148751-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse