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General NPI Number Information
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NPI Number | 1659758860
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Entity Type | Individual
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Provider Name | MARY WELLER AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1504 YANKEE PARK PL
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City | DAYTON
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State | OH
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Zip | 45458-1878
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Country | US
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Telephone | 937-424-3068
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Fax | 937-496-5401
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Provider Business Mailing Address
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Address Line | 1504 YANKEE PARK PL
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City | DAYTON
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State | OH
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Zip | 45458-1878
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Country | US
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Telephone | 937-424-3068
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Fax | 937-496-5401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN317029
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA.18775-NP
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License Number State | OH
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