Provider Demographics
NPI:1164906269
Name:COUILLARD, KIRSTEN (RN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:COUILLARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JAMES PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2906
Mailing Address - Country:US
Mailing Address - Phone:917-923-8729
Mailing Address - Fax:
Practice Address - Street 1:6 JAMES PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2906
Practice Address - Country:US
Practice Address - Phone:917-923-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY492806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY492806OtherREGISTERED NURSE