Provider Demographics
NPI:1912132515
Name:WOLF, VIRGINIA W (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:W
Last Name:WOLF
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CDE LDN
Mailing Address - Street 1:407 N HERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3816
Mailing Address - Country:US
Mailing Address - Phone:919-583-9788
Mailing Address - Fax:919-583-9790
Practice Address - Street 1:407 N HERMAN ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3816
Practice Address - Country:US
Practice Address - Phone:919-583-9788
Practice Address - Fax:919-583-9790
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001300133N00000X
NC725705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013390335OtherNPI
NC1912132515OtherBLUE CROSS/BLUE SHIELD OF NC