Provider Demographics
NPI:1427883644
Name:TIDEWATER WELLNESS, LLC
Entity type:Organization
Organization Name:TIDEWATER WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ROWE
Authorized Official - Last Name:DINGUS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, FNP, PMHNP
Authorized Official - Phone:443-892-1811
Mailing Address - Street 1:617 FRANKLIN AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1358
Mailing Address - Country:US
Mailing Address - Phone:443-892-1811
Mailing Address - Fax:908-484-9585
Practice Address - Street 1:617 FRANKLIN AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1358
Practice Address - Country:US
Practice Address - Phone:443-892-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty