Provider Demographics
NPI:1891101507
Name:WALBORN, JEAN (RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:WALBORN
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:CZYZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:806 ACQUONI RD
Mailing Address - Street 2:CALLER BOX C-268
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:828-497-1723
Practice Address - Street 1:CALLER BOX C-268
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-9253
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:828-497-1723
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
706031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL003074OtherNC BOARD D/N