Provider Demographics
NPI:1790100741
Name:WELLS, RACHEL N (CSFA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:WELLS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4128
Mailing Address - Country:US
Mailing Address - Phone:985-373-0717
Mailing Address - Fax:985-727-3259
Practice Address - Street 1:103 CARMEL DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4128
Practice Address - Country:US
Practice Address - Phone:985-373-0717
Practice Address - Fax:985-727-3259
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
145863OtherNATIONAL CSFA CERTIFICATE#