Provider Demographics
NPI:1659787679
Name:WELLS, SARAH (CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 TIMBER LINE RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4015
Mailing Address - Country:US
Mailing Address - Phone:419-891-9333
Mailing Address - Fax:
Practice Address - Street 1:1725 TIMBER LINE RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4015
Practice Address - Country:US
Practice Address - Phone:419-891-9333
Practice Address - Fax:419-824-5744
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-15973-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106856Medicaid