Provider Demographics
NPI:1144003666
Name:WELLS, SHANNON DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DENISE
Last Name:WELLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 DAYTON GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-1100
Mailing Address - Country:US
Mailing Address - Phone:937-895-0081
Mailing Address - Fax:937-895-0066
Practice Address - Street 1:1868 DAYTON GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1100
Practice Address - Country:US
Practice Address - Phone:937-895-0081
Practice Address - Fax:937-895-0066
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily