Dolly Marie Coullard, NP-C
Individual provider Active NPI Family Nurse Practitioner · Brimley, MI
NPI 1245516152 · NPPES record last updated Jan 10, 2025
Key facts
- NPI
- 1245516152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704261006 (MI)
- Practice address
- 12455 W Lakeshore Dr
Brimley, MI 49715-9403 - Phone
- (906) 248-5527
- Fax
- (906) 248-3866
- NPI assigned
- Oct 25, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130312000596 | MI | Practitioner - Nurse Practitioner | 4284889536 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704261006 | MI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Mills Indian Community | Current |
Accepting new patients | |
| Bay Mills Indian Community | Current | Accepting new patients | |
| Bay Mills Indian Community | Current |
Accepting new patients |
Locations
12455 W Lakeshore Dr
Brimley, MI 49715
Phone (906) 248-5527
12124 W Lakeshore Dr
Brimley, MI 49715
Phone (906) 248-5527
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704261006 | MI | Yes |
Addresses
Primary practice location
12455 W Lakeshore Dr
Brimley, MI 49715-9403
Mailing address
6151 S Mackinac TRL
Sault Sainte Marie, MI 49783-8974
Phone (906) 322-6702
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704261006 | Other | MI | STATE LICENSURE |
Other providers in Brimley, MI
- Bay Mills Indian Community
- Bay Mills Indian Community
- Bay Mills Indian Community
- Teresa Noele Besler
- Brett Elizabeth Carr
- Lucy Parish Dewildt
- Lynda Gregorini
- Rachel Lindsay Hileman
- Wendy K Jamros
- Miranda L Johnson
All providers in Brimley, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.