MEDICARE: MISS LOIS JEAN 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	3747P1801X	Personal Care Attendant	2069658	OH

General Provider Information

NPI Number	:	1932829959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LOIS JEAN WELLS

Provider Business Mailing Address
First Line	:	2229 STATE ROUTE 39 NW
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-7423
Country	:	US
Telephone Number	:	330-343-1645
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 STATE ROUTE 39 NW
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-7423
Country	:	US
Telephone Number	:	330-343-1645
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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Directions to “ MISS LOIS JEAN WELLS ” Practice Location

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