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General NPI Number Information
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NPI Number | 1083576003
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Entity Type | Individual
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Provider Name | CARLY WELLS RD & IBCLC
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Gender | Female
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 2451 E. BASELINE RD. #130
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City | GILBERT
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State | AZ
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Zip | 85234
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Country | US
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Telephone | 480-626-6515
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Fax | 480-507-2218
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Provider Business Mailing Address
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Address Line | 2451 E. BASELINE RD. #130
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City | GILBERT
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State | AZ
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Zip | 85234
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Country | US
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Telephone | 480-626-6515
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Fax | 480-507-2218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-313583
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 1062383
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License Number State |
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