Provider Demographics
NPI:1407453228
Name:TUSSING, CAROLINE PEARSON (RDN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PEARSON
Last Name:TUSSING
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11237 GREENSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3510
Mailing Address - Country:US
Mailing Address - Phone:443-636-0907
Mailing Address - Fax:
Practice Address - Street 1:11237 GREENSPRING AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3510
Practice Address - Country:US
Practice Address - Phone:443-636-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86153157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered