Healthcare Provider Details

I. General information

NPI: 1912132515
Provider Name (Legal Business Name): VIRGINIA WEBER WOLF RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA WEBER RD CDE LDN

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N HERMAN ST
GOLDSBORO NC
27530-3816
US

IV. Provider business mailing address

407 N HERMAN ST
GOLDSBORO NC
27530-3816
US

V. Phone/Fax

Practice location:
  • Phone: 919-583-9788
  • Fax: 919-583-9790
Mailing address:
  • Phone: 919-583-9788
  • Fax: 919-583-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001300
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL001300
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: