Provider Demographics
NPI:1235304858
Name:WELLS, AQUILLA (RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:AQUILLA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4675
Mailing Address - Country:US
Mailing Address - Phone:610-761-6734
Mailing Address - Fax:610-436-4743
Practice Address - Street 1:134 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3077
Practice Address - Country:US
Practice Address - Phone:610-761-6734
Practice Address - Fax:610-436-4743
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered