MEDICARE: JESSICA C WELLS

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1376291344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA C WELLS

Provider Business Mailing Address
First Line	:	5017 WOLF CREEK PIKE LOT 44
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-2444
Country	:	US
Telephone Number	:	937-993-6785
Fax Number	:

Provider Business Practice Location Address
First Line	:	5017 WOLF CREEK PIKE LOT 44
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-2444
Country	:	US
Telephone Number	:	937-993-6785
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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Directions to “ JESSICA C WELLS ” Practice Location

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