Provider Demographics
NPI:1770048787
Name:WELLS, HEATHER R
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7448 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1442
Mailing Address - Country:US
Mailing Address - Phone:513-464-6611
Mailing Address - Fax:
Practice Address - Street 1:726 E MAIN ST STE F #205
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1900
Practice Address - Country:US
Practice Address - Phone:513-464-6611
Practice Address - Fax:513-409-5086
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024157363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care