Healthcare Provider Details

I. General information

NPI: 1760956510
Provider Name (Legal Business Name): CHRISTINE WELLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR STE 200A
MEDINA OH
44256-3440
US

IV. Provider business mailing address

6782 LEGACY LN
WADSWORTH OH
44281-6100
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax:
Mailing address:
  • Phone: 330-328-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number374915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: