Provider Demographics
NPI:1003089830
Name:TUITT, MARY ELLEN (RD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:TUITT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-6770
Mailing Address - Fax:
Practice Address - Street 1:1710 KERNERSVILLE MEDICAL PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7157
Practice Address - Country:US
Practice Address - Phone:336-718-6770
Practice Address - Fax:336-277-1889
Is Sole Proprietor?:No
Enumeration Date:2008-04-13
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2993130OtherMEDICARE PTAN