Healthcare Provider Details

I. General information

NPI: 1760972665
Provider Name (Legal Business Name): MICHELLE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PL STE 250
BEACHWOOD OH
44122-4438
US

IV. Provider business mailing address

11308 CLAREBIRD AVE
CLEVELAND OH
44105-2541
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-5680
  • Fax:
Mailing address:
  • Phone: 216-287-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number022308
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number022308
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number022308
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number022308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: