Provider Demographics
NPI:1700757903
Name:KOULEN, VANESSA (RN)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:KOULEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 VENETIAN PROMENADE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6736
Mailing Address - Country:US
Mailing Address - Phone:917-929-2089
Mailing Address - Fax:
Practice Address - Street 1:115 VENETIAN PROMENADE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6736
Practice Address - Country:US
Practice Address - Phone:917-929-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY789648163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse