Provider Demographics
NPI:1083489538
Name:ANNIE WELLS NUTRITION LLC
Entity Type:Organization
Organization Name:ANNIE WELLS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:385-881-7717
Mailing Address - Street 1:1930 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6143
Mailing Address - Country:US
Mailing Address - Phone:385-881-7717
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 505
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3222
Practice Address - Country:US
Practice Address - Phone:319-382-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty