Provider Demographics
NPI:1710486055
Name:WELLS, ALAYA TENE
Entity Type:Individual
Prefix:
First Name:ALAYA
Middle Name:TENE
Last Name:WELLS
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 1:629 WILSON CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3493
Mailing Address - Country:US
Mailing Address - Phone:240-708-6707
Mailing Address - Fax:
Practice Address - Street 1:629 WILSON CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3493
Practice Address - Country:US
Practice Address - Phone:240-708-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant