Provider Demographics
NPI:1477164465
Name:PASZKOWSKI, BETHANY TAYLOR
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:TAYLOR
Last Name:PASZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 INDEPENDENCE BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3717
Mailing Address - Country:US
Mailing Address - Phone:717-331-0870
Mailing Address - Fax:
Practice Address - Street 1:5129 OLEANDER DR STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7062
Practice Address - Country:US
Practice Address - Phone:910-663-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered