Tidewater Nutrition & Wellness LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

TIDEWATER NUTRITION & WELLNESS LLC

Practice address

52 Cove St
Portland, ME 04101-2514

Phone

(207) 358-0154

NPI assigned

Sep 18, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristine Taylor, MS, RDN, LD

Title

Registered Dietitian/Owner

Phone

(207) 358-0154

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1720638992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 COVE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 COVE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012514",
            "telephone_number": "207-358-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER NUTRITION & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN/OWNER",
        "authorized_official_telephone_number": "207-358-0154",
        "authorized_official_credential": "MS, RDN, LD"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thrivepoint Solutions, LLC
• Thriveworks Telepsychiatry - Maine
• Margaret Thumm, FNP
• Mark E. Thurlow, LCSW
• Jacylin Ticatic, MD
• Lois Tiedeken, ANP
• Benjamin Tierney-Trevor, LCSW
• Danyelle M. Tierney, DO
• Linda RF Tiffany, LCPC, LADC
• Angela Pizzo Tillotson, FNP

• All providers in Portland, ME
• Nutritionist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.