Provider Demographics
NPI:1023775129
Name:WELLS, DELENA
Entity type:Individual
Prefix:MRS
First Name:DELENA
Middle Name:
Last Name:WELLS
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:WILKESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45695-0053
Mailing Address - Country:US
Mailing Address - Phone:740-669-6565
Mailing Address - Fax:
Practice Address - Street 1:116 S TOWN STREET
Practice Address - Street 2:
Practice Address - City:WILKESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45695
Practice Address - Country:US
Practice Address - Phone:740-669-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3747P1801XMedicaid