Healthcare Provider Details

I. General information

NPI: 1316420458
Provider Name (Legal Business Name): SKYE W. WELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SKYE W. PATTERSON

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256-2170
US

IV. Provider business mailing address

2940 INDIAN RUN
WOOSTER OH
44691-9758
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax:
Mailing address:
  • Phone: 330-749-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005695RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: