Individual
MRS. HEIDI MARIE WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD CSSD LD
Contact information
Practice address
546 JAYHAWK DR, CHENEY, KS 67025-9174
(316) 540-6054
Mailing address
546 JAYHAWK DR, CHENEY, KS 67025-9174
(316) 540-6054
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1253
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110173010
MEDICARE
KS
05
—
200366290B
—
KS
Enumeration date
07/16/2008
Last updated
09/01/2011
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