MEDICARE: PRIN KULWATNO MPS, RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1101X	Gerontological Nutrition Registered Dietitian	DI200001437	DC

General Provider Information

NPI Number	:	1497552442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIN KULWATNO MPS, RDN, LDN

Provider Business Mailing Address
First Line	:	1924 STORM DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-1413
Country	:	US
Telephone Number	:	703-336-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 STORM DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-1413
Country	:	US
Telephone Number	:	703-336-3205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	05/26/2025

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