Healthcare Provider Details

I. General information

NPI: 1336078294
Provider Name (Legal Business Name): ROBERT WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 S DORSET RD STE 301
TROY OH
45373-4748
US

IV. Provider business mailing address

998 S DORSET RD STE 301
TROY OH
45373-4748
US

V. Phone/Fax

Practice location:
  • Phone: 937-339-9865
  • Fax:
Mailing address:
  • Phone: 937-339-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: