Basic Information
| Provider Information | |||||||||
| NPI: | 1013469204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILBORN | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | HEATHER RAE | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 AUBREYS LOOP | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245925054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345173879 | ||||||||
| FaxNumber: | 4345173989 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 AUBREYS LOOP | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245925054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345173879 | ||||||||
| FaxNumber: | 4345173989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024174213 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.