MEDICARE: ALEXIS BIANCA WELLS MPH, RD,LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86119535	TX

General Provider Information

NPI Number	:	1154961704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS BIANCA WELLS MPH, RD,LD

Provider Business Mailing Address
First Line	:	14111 VANCE JACKSON RD APT 12107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2173
Country	:	US
Telephone Number	:	956-455-3142
Fax Number	:

Provider Business Practice Location Address
First Line	:	14111 VANCE JACKSON RD APT 12107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2173
Country	:	US
Telephone Number	:	956-455-3142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	01/12/2020

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