Organization
TIDEWATER NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY RUSCH RDN, LDN (REGISTERED DIETITIAN)
(410) 279-0621
Entity
Organization
Contact information
Practice address
120 MCKENNEY LN, CENTREVILLE, MD 21617-2139
(410) 279-0621
Mailing address
600-B ABRUZZI DRIVE, PMB #120, CHESTER, MD 21619
(410) 279-0621
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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