Healthcare Provider Details

I. General information

NPI: 1164720496
Provider Name (Legal Business Name): JENNIFER OPPENHEIM PASCHALOUDIS MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 GALLERIA AVE REX NUTRITION SERVICES
RALEIGH NC
27614-8137
US

IV. Provider business mailing address

4200 LAKE BOONE TRL REX NUTRITION SERVICES
RALEIGH NC
27607-6521
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-1511
  • Fax: 919-570-1511
Mailing address:
  • Phone: 919-784-1371
  • Fax: 919-784-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: