# COASTAL NUTRITION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750694170
- **Authorized official:** MS. HEIDI LYNN KAUFMAN MS LDN CDE (CLINICAL NUTRITIONIST)
- **Authorized official phone:** (910) 762-9701

## Contact information

- **Practice address:** 1612 DOCTORS CIR, WILMINGTON, NC 28401-7406
- **Practice address phone:** (910) 762-9701
- **Practice address fax:** (910) 762-9705
- **Mailing address:** 1612 DOCTORS CIR, WILMINGTON, NC 28401-7406
- **Mailing address phone:** (910) 762-9701
- **Mailing address fax:** (910) 762-9705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | L000491 | NC | Yes |

## Other

- **Enumeration date:** 07/15/2010
- **Last updated:** 07/15/2010