Provider Demographics
NPI:1730617440
Name:WILBURT, CAROLYN (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WILBURT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 TWIN CREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4085
Mailing Address - Country:US
Mailing Address - Phone:804-814-7252
Mailing Address - Fax:
Practice Address - Street 1:230 TWIN CREST DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4085
Practice Address - Country:US
Practice Address - Phone:804-814-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001125211163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant