Provider Demographics
NPI:1043511298
Name:COULES, DONNA P (PA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:P
Last Name:COULES
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 1:2499 FARMERS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3814
Mailing Address - Country:US
Mailing Address - Phone:516-809-5415
Mailing Address - Fax:
Practice Address - Street 1:222 ROCKAWAY TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1833
Practice Address - Country:US
Practice Address - Phone:516-239-1800
Practice Address - Fax:516-239-5553
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004339363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical