Provider Demographics
NPI:1982368312
Name:MEDLIN, VICTORIA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:KEREKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:1172 ARBORETUM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-5239
Mailing Address - Country:US
Mailing Address - Phone:910-632-4338
Mailing Address - Fax:
Practice Address - Street 1:2410 LILYTREE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7072
Practice Address - Country:US
Practice Address - Phone:910-632-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
HI272-LD133V00000X
SC2476133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered