MEDICARE: NICOLETTE COULSON PMHNP-BC

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	490102	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0035626	OH

General Provider Information

NPI Number	:	1548996945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE COULSON PMHNP-BC

Provider Business Mailing Address
First Line	:	3440 SILSBY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-3651
Country	:	US
Telephone Number	:	806-410-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 SILSBY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-3651
Country	:	US
Telephone Number	:	806-410-6415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	01/17/2024

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