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General NPI Number Information
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NPI Number | 1861172835
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Entity Type | Organization
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Legal Business Name | COASTLINE HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 4300B W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-2568
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Country | US
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Telephone | 228-669-1427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 133
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City | PERKINSTON
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State | MS
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Zip | 39573-0003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | AMANDA ZEIGLER
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Credential | RD
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Telephone | 228-669-1427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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