Provider Demographics
NPI:1164720496
Name:PASCHALOUDIS, JENNIFER OPPENHEIM (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:OPPENHEIM
Last Name:PASCHALOUDIS
Suffix:
Gender:F
Credentials:MS, RD, LDN
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4200 LAKE BOONE TRL
Mailing Address - Street 2:REX NUTRITION SERVICES
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6521
Mailing Address - Country:US
Mailing Address - Phone:919-784-1371
Mailing Address - Fax:919-784-1397
Practice Address - Street 1:11200 GALLERIA AVE
Practice Address - Street 2:REX NUTRITION SERVICES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8137
Practice Address - Country:US
Practice Address - Phone:919-570-1511
Practice Address - Fax:919-570-1511
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ40914AOtherMEDICARE PTAN
NCQ40914E853OtherMEDICARE PTAN