Provider Demographics
NPI:1639646367
Name:MEDINS, CAROL MARY (MPH, RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARY
Last Name:MEDINS
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CNSC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MARY
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SCOTTS RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6584
Mailing Address - Country:US
Mailing Address - Phone:919-302-3648
Mailing Address - Fax:
Practice Address - Street 1:WAKEMED RALEIGH MEDICAL PARK
Practice Address - Street 2:23 SUNNYBROOK ROAD, SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-235-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002778133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric