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General NPI Number Information
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NPI Number | 1306319223
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Entity Type | Individual
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Provider Name | JESSICA PRICE D'ARGENIO WALLER M.S., C.N.S., L.D.N.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 2000 GIRARD AVE
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City | BALTIMORE
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State | MD
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Zip | 21211-1595
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Country | US
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Telephone | 443-328-4842
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 MCDONOGH RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-1009
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Country | US
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Telephone | 410-591-1297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX4415
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License Number State | MD
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