Organization
MD NUTRITION AND LIFESTYLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARA MICHELE DAVIS MS, RD, CDN, LPN (CLINICAL DIETITAN)
(860) 796-1930
Entity
Organization
Contact information
Practice address
5901 KINGSTOWNE VILLAGE PKWY, SUITE 300, KINGSTOWNE, VA 22315
(860) 796-1930
Mailing address
95 BRETTON RD, MIDDLETOWN, CT 06457
(860) 796-1930
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
001415
CT
133V00000X
Registered Dietitian
Primary
L002913
NC
Other
Enumeration date
02/12/2018
Last updated
02/12/2018
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