Provider Demographics
NPI:1215790043
Name:WELLS, MICHAEL SHANE (PRSS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:WELLS
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-1127
Mailing Address - Country:US
Mailing Address - Phone:304-918-4516
Mailing Address - Fax:
Practice Address - Street 1:114 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-1127
Practice Address - Country:US
Practice Address - Phone:304-918-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist