Healthcare Provider Details

I. General information

NPI: 1245516152
Provider Name (Legal Business Name): DOLLY MARIE COULLARD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 W LAKESHORE DR
BRIMLEY MI
49715-9403
US

IV. Provider business mailing address

6151 S MACKINAC TRL
SAULT SAINTE MARIE MI
49783-8974
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-5527
  • Fax: 906-248-3866
Mailing address:
  • Phone: 906-322-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: