MEDICARE: CHELSIE COASTER RD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1026690	MI
2	174400000X	Specialist	21310068	MI

General Provider Information

NPI Number	:	1922433887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSIE COASTER RD, CDE

Provider Business Mailing Address
First Line	:	2024 16TH ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6135
Country	:	US
Telephone Number	:	586-531-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 16TH ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6135
Country	:	US
Telephone Number	:	586-531-3096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	01/20/2026

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