Provider Demographics
NPI:1013390335
Name:VIRGINIA W WOLF
Entity Type:Organization
Organization Name:VIRGINIA W WOLF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:RD CDE LDN
Authorized Official - Phone:919-396-2248
Mailing Address - Street 1:102 TEAL CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9550
Mailing Address - Country:US
Mailing Address - Phone:919-583-9788
Mailing Address - Fax:919-583-9790
Practice Address - Street 1:407 N HERMAN ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3816
Practice Address - Country:US
Practice Address - Phone:919-396-2248
Practice Address - Fax:919-583-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912132515OtherNC BLUE CROSS AND BLUE SHEILD