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General NPI Number Information
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NPI Number | 1245516152
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Entity Type | Individual
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Provider Name | DOLLY MARIE COULLARD NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 12455 W LAKESHORE DR
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City | BRIMLEY
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State | MI
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Zip | 49715-9403
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Country | US
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Telephone | 906-248-5527
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Fax | 906-248-3866
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Provider Business Mailing Address
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Address Line | 6151 S MACKINAC TRL
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-8974
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Country | US
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Telephone | 906-322-6702
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704261006
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License Number State | MI
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