Healthcare Provider Details

I. General information

NPI: 1265097521
Provider Name (Legal Business Name): WELLS RESEARCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E STROOP RD
KETTERING OH
45429-3224
US

IV. Provider business mailing address

513 E STROOP RD
KETTERING OH
45429-3224
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-2157
  • Fax: 937-293-1763
Mailing address:
  • Phone: 937-293-2157
  • Fax: 937-293-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. PAULA JEAN WELLS
Title or Position: OWNER
Credential: RN
Phone: 937-293-2157