Healthcare Provider Details

I. General information

NPI: 1487399804
Provider Name (Legal Business Name): MOLLIE KATHLEEN WELLS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W EXCHANGE ST
AKRON OH
44302-1711
US

IV. Provider business mailing address

1966 WILLOWDALE DR
STOW OH
44224-1836
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-2671
  • Fax:
Mailing address:
  • Phone: 330-696-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031149
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: