Basic Information
| Provider Information | |||||||||
| NPI: | 1164720496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCHALOUDIS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | OPPENHEIM | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 LAKE BOONE TRL | ||||||||
| Address2: | REX NUTRITION SERVICES | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197841371 | ||||||||
| FaxNumber: | 9197841397 | ||||||||
| Practice Location | |||||||||
| Address1: | 11200 GALLERIA AVE | ||||||||
| Address2: | REX NUTRITION SERVICES | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276148137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195701511 | ||||||||
| FaxNumber: | 9195701511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | Q40914A | 01 | NC | MEDICARE PTAN | OTHER | Q40914E853 | 01 | NC | MEDICARE PTAN | OTHER |