Provider Demographics
NPI:1902500846
Name:GOODWIN, CELESTE JUANITA KURZ (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:JUANITA KURZ
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PUREFOY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4858
Mailing Address - Country:US
Mailing Address - Phone:860-951-1632
Mailing Address - Fax:
Practice Address - Street 1:303 PUREFOY RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4858
Practice Address - Country:US
Practice Address - Phone:860-951-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered