Provider Demographics
NPI:1013298645
Name:WELLMAN, JENNIFER M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-234-8885
Mailing Address - Fax:304-234-1838
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-234-8885
Practice Address - Fax:304-234-1838
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH268729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054175Medicaid
WV3810021209Medicaid
WVWV1677AMedicare PIN