Provider Demographics
NPI:1548679954
Name:WALBURN, UNITA
Entity type:Individual
Prefix:
First Name:UNITA
Middle Name:
Last Name:WALBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12512 POND WALK LN
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-8359
Mailing Address - Country:US
Mailing Address - Phone:540-848-4878
Mailing Address - Fax:
Practice Address - Street 1:121 W LOCUST ST
Practice Address - Street 2:SUITE 113
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3160
Practice Address - Country:US
Practice Address - Phone:540-848-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10300460570F001133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist