Provider Demographics
NPI:1003180290
Name:WEALE, VIRGINIA (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:WEALE
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2177
Mailing Address - Country:US
Mailing Address - Phone:513-272-0313
Mailing Address - Fax:513-272-0316
Practice Address - Street 1:4440 RED BANK RD STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2177
Practice Address - Country:US
Practice Address - Phone:513-272-0313
Practice Address - Fax:513-272-0316
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3503133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered