Provider Demographics
NPI:1346602158
Name:COULTER, SHETA (RN)
Entity Type:Individual
Prefix:MS
First Name:SHETA
Middle Name:
Last Name:COULTER
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 1:15516 MYRTLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4139
Mailing Address - Country:US
Mailing Address - Phone:708-625-8046
Mailing Address - Fax:
Practice Address - Street 1:15516 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4139
Practice Address - Country:US
Practice Address - Phone:708-625-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide