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Contact Information

TIDEWATER NUTRITION & WELLNESS LLC
52 COVE ST
PORTLAND, ME04101-2514
 Phone: 207-358-0154
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for TIDEWATER NUTRITION & WELLNESS LLC

NPI Number 1720638992
LBN Legal business name TIDEWATER NUTRITION & WELLNESS LLC
Authorized official KRISTINE TAYLOR - (REGISTERED DIETITIAN/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/18/2019
Last updated 09/18/2019 - About 7 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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