Provider Demographics
NPI:1417506403
Name:COULOOTE, ANNISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANNISE
Middle Name:
Last Name:COULOOTE
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 1:13420 HICKORY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6546
Mailing Address - Country:US
Mailing Address - Phone:240-423-5746
Mailing Address - Fax:
Practice Address - Street 1:13420 HICKORY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6546
Practice Address - Country:US
Practice Address - Phone:240-423-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX934859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse