Provider Demographics
NPI:1194288894
Name:WELLS, MELISSA JOANNE (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOANNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4340
Mailing Address - Country:US
Mailing Address - Phone:607-201-6285
Mailing Address - Fax:
Practice Address - Street 1:41 EDWARD ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4340
Practice Address - Country:US
Practice Address - Phone:607-201-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332303-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse