Provider Demographics
NPI:1720675333
Name:WELLS, ANGELETT RENEE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELETT
Middle Name:RENEE
Last Name:WELLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 TRADER CT E APT 20
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-3634
Mailing Address - Country:US
Mailing Address - Phone:574-383-4340
Mailing Address - Fax:
Practice Address - Street 1:2676 TRADER CT E APT 20
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3634
Practice Address - Country:US
Practice Address - Phone:574-383-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
IN28226793A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility