Healthcare Provider Details

I. General information

NPI: 1356864045
Provider Name (Legal Business Name): ANGELA JANE WELLS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BAY PARK DR STE 300
OREGON OH
43616-4922
US

IV. Provider business mailing address

2751 BAY PARK DR STE 300
OREGON OH
43616-4922
US

V. Phone/Fax

Practice location:
  • Phone: 419-690-7596
  • Fax: 419-697-6707
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.019339
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704304219
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: