MEDICARE: MS. JENNIFER OPPENHEIM PASCHALOUDIS MS, RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	L002183	NC
2	133V00000X	Registered Dietitian	L002183	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q40914A	OTHER	NC	MEDICARE PTAN
2	Q40914E853	OTHER	NC	MEDICARE PTAN

General Provider Information

NPI Number	:	1164720496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER OPPENHEIM PASCHALOUDIS MS, RD, LDN

Provider Business Mailing Address
First Line	:	4200 LAKE BOONE TRL
Second Line	:	REX NUTRITION SERVICES
City	:	RALEIGH
State	:	NC
Zip	:	27607-6521
Country	:	US
Telephone Number	:	919-784-1371
Fax Number	:	919-784-1397

Provider Business Practice Location Address
First Line	:	11200 GALLERIA AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8137
Country	:	US
Telephone Number	:	919-784-3419
Fax Number	:	919-784-3094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	04/02/2026

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