Tidewater Nutrition & Wellness LLC

NPI #1720638992 in Portland, Maine

Provider Information

NPI Number: 1720638992
Entity Type: Organization
Organization Name: Tidewater Nutrition & Wellness LLC
Primary Specialty: Nutritionist
Enumeration Date: Sep 18, 2019
Last Updated: Sep 18, 2019

Practice Location

Address: 52 COVE ST
City: Portland
State: Maine
ZIP Code: 04101-2514
Phone: (207) 358-0154

Authorized Official

Name: KRISTINE TAYLOR, MS, RDN, LD
Title: REGISTERED DIETITIAN/OWNER
Phone: (207) 358-0154

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nutritionist	133N00000X	Primary

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