Provider Demographics
NPI:1417326737
Name:WELLS, CAMERON (RD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N ORANGE ST
Mailing Address - Street 2:STE 304
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2928
Mailing Address - Country:US
Mailing Address - Phone:202-527-7500
Mailing Address - Fax:202-527-7400
Practice Address - Street 1:5100 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 401
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4119
Practice Address - Country:US
Practice Address - Phone:202-527-7500
Practice Address - Fax:202-527-7400
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDI100000668OtherGOVERNMENT OF DC - DOH