Provider Demographics
NPI:1629851118
Name:COULTER, ABIGAIL LUWEN (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LUWEN
Last Name:COULTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MAIN ST APT 110
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2142
Mailing Address - Country:US
Mailing Address - Phone:734-355-4195
Mailing Address - Fax:
Practice Address - Street 1:2221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7132
Practice Address - Country:US
Practice Address - Phone:419-251-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant