Provider Demographics
NPI:1598359960
Name:COUDRIET, MICHAEL DONALD (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DONALD
Last Name:COUDRIET
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-582-2930
Mailing Address - Fax:360-582-2931
Practice Address - Street 1:840 N 5TH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-582-2930
Practice Address - Fax:360-582-2931
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61149647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner