MEDICARE: SHANNON DENISE WELLS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0034634	OH

General Provider Information

NPI Number	:	1144003666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DENISE WELLS FNP-C

Provider Business Mailing Address
First Line	:	1868 DAYTON GERMANTOWN PIKE
Second Line	:
City	:	GERMANTOWN
State	:	OH
Zip	:	45327-1100
Country	:	US
Telephone Number	:	937-895-0081
Fax Number	:	937-895-0066

Provider Business Practice Location Address
First Line	:	1868 DAYTON GERMANTOWN PIKE
Second Line	:
City	:	GERMANTOWN
State	:	OH
Zip	:	45327-1100
Country	:	US
Telephone Number	:	937-895-0081
Fax Number	:	937-895-0066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	11/07/2024

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