Provider Demographics
NPI:1477236941
Name:WOODBURN, LEAH ALICE (RD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ALICE
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:LOUIS A JOHNSON VA MEDICAL CENTER
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4119
Mailing Address - Country:US
Mailing Address - Phone:304-641-2794
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:LOUIS A JOHNSON VA MEDICAL CENTER
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4119
Practice Address - Country:US
Practice Address - Phone:304-641-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV895884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered