Provider Demographics
NPI:1437488988
Name:MUBANDA, EDITH N (RD,LDN)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:N
Last Name:MUBANDA
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 POPLAR GROVE CONNECTOR
Mailing Address - Street 2:WATAUGA COUNTY HEALTH DEPARTMENT
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5915
Mailing Address - Country:US
Mailing Address - Phone:828-264-4995
Mailing Address - Fax:828-264-4997
Practice Address - Street 1:126 POPLAR GROVE CONNECTOR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-264-4995
Practice Address - Fax:828-264-4997
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000686133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered