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General NPI Number Information
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NPI Number | 1427883644
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Entity Type | Organization
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Legal Business Name | TIDEWATER WELLNESS, LLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 617 FRANKLIN AVE UNIT 7
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City | BERLIN
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State | MD
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Zip | 21811-1358
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Country | US
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Telephone | 443-892-1811
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Fax |
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Provider Business Mailing Address
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Address Line | 617 FRANKLIN AVE UNIT 7
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City | BERLIN
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State | MD
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Zip | 21811-1358
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Country | US
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Telephone | 443-892-1811
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Fax | 908-484-9585
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Authorized Official
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Title or Position | PMHNP
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Name | MEGAN ROWE DINGUS
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Credential | CRNP, FNP, PMHNP
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Telephone | 443-892-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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