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General NPI Number Information
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NPI Number | 1255882254
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Entity Type | Organization
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Legal Business Name | PENINSULA REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 909 PROGRESS CIRCLE PENINSULA REGIONAL WEIGHT LOSS & WELLNESS CENTER
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City | SALISBURY
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State | MD
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Zip | 21804
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Country | US
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Telephone | 410-677-1043
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E CARROLL ST PRMC
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City | SALISBURY
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State | MD
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Zip | 21801
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Country | US
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Telephone | 410-677-1043
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | JEANETTE NYCE
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Credential | RDN, LDN
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Telephone | 410-677-1043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | DX3456
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License Number State | MD
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