Provider Demographics
NPI:1497107684
Name:CAROLINA NUTRITION SPECIALISTS
Entity Type:Organization
Organization Name:CAROLINA NUTRITION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:COVINGTON
Authorized Official - Last Name:MIKOLAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:919-215-7609
Mailing Address - Street 1:7124 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-6822
Mailing Address - Country:US
Mailing Address - Phone:919-215-7609
Mailing Address - Fax:
Practice Address - Street 1:401 N WEST ST
Practice Address - Street 2:SUITE 121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1399
Practice Address - Country:US
Practice Address - Phone:919-215-7609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001101261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service