Provider Demographics
NPI:1689840241
Name:COULTER, DENISE LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LYNN
Last Name:COULTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3220
Mailing Address - Country:US
Mailing Address - Phone:330-793-7878
Mailing Address - Fax:
Practice Address - Street 1:167 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3220
Practice Address - Country:US
Practice Address - Phone:330-793-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN102504164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse