Provider Demographics
NPI:1770017352
Name:WELLS, DEBRA (CNA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:106 E HOUGHTON
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953
Mailing Address - Country:US
Mailing Address - Phone:217-493-1678
Mailing Address - Fax:
Practice Address - Street 1:106 E HOUGHTON ST
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-1610
Practice Address - Country:US
Practice Address - Phone:217-493-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide