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General NPI Number Information
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NPI Number | 1497107684
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Entity Type | Organization
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Legal Business Name | CAROLINA NUTRITION SPECIALISTS
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 401 N WEST ST SUITE 121
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City | RALEIGH
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State | NC
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Zip | 27603-1399
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Country | US
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Telephone | 919-215-7609
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Fax |
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Provider Business Mailing Address
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Address Line | 7124 EASTRIDGE DR
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City | APEX
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State | NC
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Zip | 27539-6822
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Country | US
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Telephone | 919-215-7609
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, NUTRITIONIST
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Name | BETSY COVINGTON MIKOLAJEWSKI
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Credential | RDN
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Telephone | 919-215-7609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 001101
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License Number State | NC
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