Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN126619NP | GA |
NPI | 1134257686 |
---|---|
Provider Name | Ms. Denise Coultes |
First Address | Atlanta, GA 30329-2208 |
Second Address | Atlanta, GA 30329-2208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 24/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P41251 | (02) | GA |