Provider Demographics
NPI:1932829959
Name:WELLS, LOIS JEAN
Entity Type:Individual
Prefix:MISS
First Name:LOIS
Middle Name:JEAN
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 1:2229 STATE ROUTE 39 NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7423
Mailing Address - Country:US
Mailing Address - Phone:330-343-1645
Mailing Address - Fax:
Practice Address - Street 1:2229 STATE ROUTE 39 NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7423
Practice Address - Country:US
Practice Address - Phone:330-343-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20696583747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant