Provider Demographics
NPI:1861118697
Name:WELLS, MICHELE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 SUGAR TREE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2809
Mailing Address - Country:US
Mailing Address - Phone:757-297-2019
Mailing Address - Fax:
Practice Address - Street 1:1401 KRISTINA WAY STE 203
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8917
Practice Address - Country:US
Practice Address - Phone:757-297-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225700000X.225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019018056OtherVIRGINIA NURSING BOARD