Provider Demographics
NPI:1710411384
Name:WELLS, GABRIEL (BSNUTR)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:BSNUTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 FLAMINGO LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-3445
Mailing Address - Country:US
Mailing Address - Phone:409-460-4700
Mailing Address - Fax:
Practice Address - Street 1:4325 FLAMINGO LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-3445
Practice Address - Country:US
Practice Address - Phone:409-460-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education