Provider Demographics
NPI:1356130116
Name:WELLS, ANIEDRA GERALDINE (CPRSS, CHW-I)
Entity type:Individual
Prefix:
First Name:ANIEDRA
Middle Name:GERALDINE
Last Name:WELLS
Suffix:
Gender:
Credentials:CPRSS, CHW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5546 CAMINO AL NORTE # 2-261
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0805
Mailing Address - Country:US
Mailing Address - Phone:702-483-1230
Mailing Address - Fax:
Practice Address - Street 1:1229 PAVILIONS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2321
Practice Address - Country:US
Practice Address - Phone:702-670-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6112172V00000X
NVPRSS-5315175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker