Provider Demographics
NPI:1174755318
Name:WELLS, ROBERT K (RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:WELLS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 KELLER RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:44822-9232
Mailing Address - Country:US
Mailing Address - Phone:740-694-0907
Mailing Address - Fax:740-694-1913
Practice Address - Street 1:17330 KELLER RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:OH
Practice Address - Zip Code:44822-9232
Practice Address - Country:US
Practice Address - Phone:740-694-0907
Practice Address - Fax:740-694-1913
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN353150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse