Provider Demographics
NPI:1346036365
Name:WELLS, TRA'CHAUN
Entity type:Individual
Prefix:
First Name:TRA'CHAUN
Middle Name:
Last Name:WELLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 US HIGHWAY 46 STE 111
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2442
Mailing Address - Country:US
Mailing Address - Phone:862-746-1198
Mailing Address - Fax:
Practice Address - Street 1:373 US HIGHWAY 46 STE 111
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2442
Practice Address - Country:US
Practice Address - Phone:862-746-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory