Healthcare Provider Details

I. General information

NPI: 1073422572
Provider Name (Legal Business Name): COASTAL GRACE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BROAD STREET BOX #22
BERLIN MD
21811
US

IV. Provider business mailing address

20 BROAD STREET BOX #22
BERLIN MD
21811
US

V. Phone/Fax

Practice location:
  • Phone: 443-513-1751
  • Fax:
Mailing address:
  • Phone: 443-513-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER M MASON
Title or Position: OWNER, OPERATOR, PRACITIONER
Credential: CRNP, FNP-C
Phone: 443-513-1751