Organization
TIDEWATER NUTRITION & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE TAYLOR MS, RDN, LD (REGISTERED DIETITIAN/OWNER)
(207) 358-0154
Entity
Organization
Contact information
Practice address
52 COVE ST, PORTLAND, ME 04101-2514
(207) 358-0154
Mailing address
52 COVE ST, PORTLAND, ME 04101-2514
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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