Healthcare Provider Details

I. General information

NPI: 1225967706
Provider Name (Legal Business Name): ALEXANDRIA MARIE WELLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8309 MANOR GATE WAY
MENTOR OH
44060-5971
US

IV. Provider business mailing address

8309 MANOR GATE WAY
MENTOR OH
44060-5971
US

V. Phone/Fax

Practice location:
  • Phone: 440-296-0042
  • Fax:
Mailing address:
  • Phone: 440-296-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLPN.178516.MEDS-
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.178516.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: