Provider Demographics
NPI:1710691118
Name:WELLMAN, TINA MICHELLE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
Last Name:WELLMAN
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 1:42 PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25009-9091
Mailing Address - Country:US
Mailing Address - Phone:304-836-5505
Mailing Address - Fax:
Practice Address - Street 1:42 PARRISH LN
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:WV
Practice Address - Zip Code:25009-9091
Practice Address - Country:US
Practice Address - Phone:304-836-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide