Organization
WILDCRAFTED WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAITLIN MARIE COSTELLO CNS (NUTRITIONIST)
(410) 688-9009
Entity
Organization
Contact information
Practice address
5415 W CEDAR LN STE 202A, BETHESDA, MD 20814-1515
(301) 530-0800
Mailing address
7010 CHERRY AVE, TAKOMA PARK, MD 20912-6445
(410) 688-9009
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
02/11/2020
Last updated
02/11/2020
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