Provider Demographics
NPI:1609842533
Name:COUGHLIN, DOLORES LEHMAN (NP)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:LEHMAN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:M
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:380 COPPERFIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2402
Mailing Address - Country:US
Mailing Address - Phone:704-403-1800
Mailing Address - Fax:704-403-1836
Practice Address - Street 1:380 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-403-1800
Practice Address - Fax:704-403-1836
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC950007363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005018Medicaid
NC6005018Medicaid
NC2599500CMedicare PIN