Provider Demographics
NPI:1609227909
Name:COULTER, VANESSA ELAINE (APRN, CNP)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:ELAINE
Last Name:COULTER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ELAINE
Other - Last Name:LIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3902 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3357
Mailing Address - Country:US
Mailing Address - Phone:701-364-8900
Mailing Address - Fax:
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-364-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily