Provider Demographics
NPI:1821067745
Name:WALBURN, ROBERTA C (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
Last Name:WALBURN
Suffix:
Gender:F
Credentials:ARNP
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 6
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50147-0006
Mailing Address - Country:US
Mailing Address - Phone:641-876-2070
Mailing Address - Fax:641-876-2458
Practice Address - Street 1:100 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50147-9998
Practice Address - Country:US
Practice Address - Phone:641-876-2070
Practice Address - Fax:641-876-2458
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-048790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS94274Medicare UPIN
IA17100Medicare ID - Type Unspecified