Provider Demographics
NPI:1467853994
Name:COUGHLIN, MARY ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:COUGHLIN
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 1:89 BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-2135
Mailing Address - Country:US
Mailing Address - Phone:401-228-3960
Mailing Address - Fax:401-228-3950
Practice Address - Street 1:89 BLUFF AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-2135
Practice Address - Country:US
Practice Address - Phone:401-228-3960
Practice Address - Fax:401-228-3950
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI28474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse