Provider Demographics
NPI:1386073930
Name:CULBERTSON, ANDREA (RDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:RDN
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 387
Mailing Address - Street 2:
Mailing Address - City:CALPELLA
Mailing Address - State:CA
Mailing Address - Zip Code:95418-0387
Mailing Address - Country:US
Mailing Address - Phone:707-485-5115
Mailing Address - Fax:707-485-7792
Practice Address - Street 1:6991 N STATE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9629
Practice Address - Country:US
Practice Address - Phone:707-485-5115
Practice Address - Fax:707-485-7792
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA834332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA834332OtherCREDENTIAL VERIFICATION