Provider Demographics
NPI:1285773408
Name:WELLS, ELLEN ONEL (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ONEL
Last Name:WELLS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 COUNTY ROAD 253
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-7630
Mailing Address - Country:US
Mailing Address - Phone:254-918-7208
Mailing Address - Fax:
Practice Address - Street 1:411 N BELKNAP ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3415
Practice Address - Country:US
Practice Address - Phone:254-965-1581
Practice Address - Fax:254-965-8406
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05749133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered