Provider Demographics
NPI:1689035305
Name:WILBANKS, NANCY JOANNA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JOANNA
Last Name:WILBANKS
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 1:214 MACK LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9547
Mailing Address - Country:US
Mailing Address - Phone:985-264-8834
Mailing Address - Fax:
Practice Address - Street 1:7015 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4960
Practice Address - Country:US
Practice Address - Phone:985-234-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1758133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist