Provider Demographics
NPI:1740534643
Name:WELLS, TANYIA DELANE
Entity type:Individual
Prefix:MRS
First Name:TANYIA
Middle Name:DELANE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYIA
Other - Middle Name:DELANE
Other - Last Name:MONTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1265 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9478
Mailing Address - Country:US
Mailing Address - Phone:304-520-4608
Mailing Address - Fax:304-520-4254
Practice Address - Street 1:1265 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9478
Practice Address - Country:US
Practice Address - Phone:304-520-4608
Practice Address - Fax:304-520-4254
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45975363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology