Provider Demographics
NPI:1417430331
Name:WOOLLENS, VIRGINIA LOIS (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LOIS
Last Name:WOOLLENS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2436
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-2436
Mailing Address - Country:US
Mailing Address - Phone:919-721-5387
Mailing Address - Fax:
Practice Address - Street 1:CHINLE COMPREHENSIVE HEALTHCARE FACILITY
Practice Address - Street 2:US 191
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86108813133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered