Provider Demographics
NPI:1477069821
Name:WELLINGTON, ASHELY TARJARA CAREEN
Entity Type:Individual
Prefix:
First Name:ASHELY
Middle Name:TARJARA CAREEN
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 RUSSELL AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1725
Mailing Address - Country:US
Mailing Address - Phone:240-467-8647
Mailing Address - Fax:
Practice Address - Street 1:4212 RUSSELL AVE APT 8
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1725
Practice Address - Country:US
Practice Address - Phone:240-467-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant