Individual
CHRISTINE ELIZABETH COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP
Contact information
Practice address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002742A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178420KK
MEDICARE PTAN
IN
05
—
200922290
—
IN
Enumeration date
09/10/2008
Last updated
01/29/2019
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