Provider Demographics
NPI:1265885081
Name:WELLS, SCARLET (CNC)
Entity type:Individual
Prefix:
First Name:SCARLET
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MEHEU CIR
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3617
Mailing Address - Country:US
Mailing Address - Phone:808-280-8046
Mailing Address - Fax:
Practice Address - Street 1:109 MEHEU CIR
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3617
Practice Address - Country:US
Practice Address - Phone:808-280-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist