MEDICARE: MRS. AQUILLA WELLS RD,LDN

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	DN002200	PA

General Provider Information

NPI Number	:	1235304858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AQUILLA WELLS RD,LDN

Provider Business Mailing Address
First Line	:	329 RICHMOND RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4675
Country	:	US
Telephone Number	:	610-761-6734
Fax Number	:	610-436-4743

Provider Business Practice Location Address
First Line	:	134 N CHURCH ST
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3077
Country	:	US
Telephone Number	:	610-761-6734
Fax Number	:	610-436-4743

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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