Provider Demographics
NPI:1295927572
Name:MOZINGO, TERRI LEA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEA
Last Name:MOZINGO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 BURNT MILL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2576
Mailing Address - Country:US
Mailing Address - Phone:910-790-9500
Mailing Address - Fax:910-796-8111
Practice Address - Street 1:3240 BURNT MILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2576
Practice Address - Country:US
Practice Address - Phone:910-790-9500
Practice Address - Fax:910-796-8111
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002681133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND161F3OtherBCBSNC