Provider Demographics
NPI:1700646734
Name:WELLS, MICHELLE A
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
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 1:50820 SR 145
Mailing Address - Street 2:
Mailing Address - City:MALAGA
Mailing Address - State:OH
Mailing Address - Zip Code:43757
Mailing Address - Country:US
Mailing Address - Phone:740-320-0951
Mailing Address - Fax:
Practice Address - Street 1:50820 SR 145
Practice Address - Street 2:
Practice Address - City:MALAGA
Practice Address - State:OH
Practice Address - Zip Code:43757
Practice Address - Country:US
Practice Address - Phone:740-320-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator