Provider Demographics
NPI:1710716626
Name:CHERYL WILBER DIETITIAN
Entity type:Organization
Organization Name:CHERYL WILBER DIETITIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:870-405-3011
Mailing Address - Street 1:566 NORTHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8130
Mailing Address - Country:US
Mailing Address - Phone:870-405-3011
Mailing Address - Fax:
Practice Address - Street 1:1108 BAER ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4911
Practice Address - Country:US
Practice Address - Phone:870-405-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty