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General NPI Number Information
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NPI Number | 1982350237
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Entity Type | Organization
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Legal Business Name | COASTAL PRIMARY CARE AND WELLNESS, PLLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 7183 BEACH DR SW # 1
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City | OCEAN ISLE BEACH
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State | NC
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Zip | 28469-5634
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Country | US
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Telephone | 910-795-1700
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Fax | 910-661-0683
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Provider Business Mailing Address
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Address Line | 7183 BEACH DR SW # 1
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City | OCEAN ISLE BEACH
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State | NC
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Zip | 28469-5634
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Country | US
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Telephone | 910-795-1700
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Fax | 910-661-0683
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Authorized Official
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Title or Position | CO-MANAGER/OWNER
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Name | MRS. AMANDA L MABE
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Credential | AGNP-C
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Telephone | 336-613-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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