Provider Demographics
NPI:1801639091
Name:WELLS, OLIVIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WELLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 CREEKSIDE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2880
Mailing Address - Country:US
Mailing Address - Phone:740-502-4035
Mailing Address - Fax:
Practice Address - Street 1:2020 N ACADEMY BLVD STE 261
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1567
Practice Address - Country:US
Practice Address - Phone:719-851-5647
Practice Address - Fax:888-520-6144
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.456186163WP0808X
OHAPRN.CNP.0036675363LP0808X
COC-APN.0102498-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health