Organization
COASTAL NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HEIDI LYNN KAUFMAN MS LDN CDE (CLINICAL NUTRITIONIST)
(910) 762-9701
Entity
Organization
Contact information
Practice address
1612 DOCTORS CIR, WILMINGTON, NC 28401-7406
(910) 762-9701
(910) 762-9705
Mailing address
1612 DOCTORS CIR, WILMINGTON, NC 28401-7406
(910) 762-9701
(910) 762-9705
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
L000491
NC
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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