Provider Demographics
NPI:1104304286
Name:NORTH CAROLINA STATE UNIVERSITY
Entity type:Organization
Organization Name:NORTH CAROLINA STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR EMERITA
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LDN
Authorized Official - Phone:919-605-6169
Mailing Address - Street 1:NORTH CAROLINA STATE UNIVERSITY OFA CAMPUS BOX 7201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-7201
Mailing Address - Country:US
Mailing Address - Phone:919-513-7982
Mailing Address - Fax:
Practice Address - Street 1:4101 BERYL RD STE 230
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1002
Practice Address - Country:US
Practice Address - Phone:919-515-7665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty