Provider Demographics
NPI:1437755683
Name:KINDER, WENDI PAIGE (RD)
Entity Type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:PAIGE
Last Name:KINDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S MARSHALL ST STE 107
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5264
Mailing Address - Country:US
Mailing Address - Phone:336-407-0912
Mailing Address - Fax:
Practice Address - Street 1:306 POMONA DR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1643
Practice Address - Country:US
Practice Address - Phone:336-541-6475
Practice Address - Fax:336-541-6485
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002002133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered