Provider Demographics
NPI:1922603646
Name:WILSON, CHRISTINA (CNS, LN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNS, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HIGHPARK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1793
Mailing Address - Country:US
Mailing Address - Phone:858-682-7989
Mailing Address - Fax:
Practice Address - Street 1:615 HIGHPARK LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1793
Practice Address - Country:US
Practice Address - Phone:858-682-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNU0002133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist