Individual
CARLENE NATHLEE WELLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1512 SOUTH ST, PHILADELPHIA, PA 19146-1636
(267) 239-5637
(267) 455-0825
Mailing address
1424 KENILWORTH ST, PHILADELPHIA, PA 19146-2208
(267) 239-5637
(267) 455-0825
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN003586
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN003586
STATE LICENSE
PA
Enumeration date
02/29/2020
Last updated
02/29/2020
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