Provider Demographics
NPI:1235283714
Name:WELLS, SADIE LEIGH (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:LEIGH
Last Name:WELLS
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:LEIGH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8659 TROY MARQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-3190
Mailing Address - Country:US
Mailing Address - Phone:815-735-6194
Mailing Address - Fax:
Practice Address - Street 1:8659 TROY MARQUETTE DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-3190
Practice Address - Country:US
Practice Address - Phone:815-735-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004195133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist