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NPI Code Detail

MEDICARE: DONALD COULTER NP

MEDICARE: DONALD COULTER NP
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
1363LA2100XAcute Care Nurse Practitioner19827.1612WY

General Provider Information

NPI Number : 1093248114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD COULTER NP
Provider Business Mailing Address
First Line : 3632 AMERICAN WAY
Second Line :
City : CASPER
State : WY
Zip : 82604-3164
Country : US
Telephone Number : 307-262-0211
Fax Number :
Provider Business Practice Location Address
First Line : 3632 AMERICAN WAY
Second Line :
City : CASPER
State : WY
Zip : 82604-3164
Country : US
Telephone Number : 307-262-0211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2017
Last Update Date : 04/05/2017

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