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General NPI Number Information
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NPI Number | 1104522770
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Entity Type | Individual
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Provider Name | KAROLYN ROSE COULOURIS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 39465 W 14 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-1600
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Country | US
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Telephone | 877-906-9699
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Fax |
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Provider Business Mailing Address
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Address Line | 510 HEMPSTEAD TPKE RM 203
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-1152
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Country | US
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Telephone | 516-505-7200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704320977
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License Number State | MI
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