Provider Demographics
NPI:1699204719
Name:COUGHLIN, ALEXIYAH ROSE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIYAH
Middle Name:ROSE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:ALEXIYAH
Other - Middle Name:ROSE
Other - Last Name:KOHLER-BUSSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CBS
Mailing Address - Street 1:W3980 STATE ROAD 33
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:WI
Mailing Address - Zip Code:53923-9719
Mailing Address - Country:US
Mailing Address - Phone:608-330-1755
Mailing Address - Fax:
Practice Address - Street 1:W3980 STATE ROAD 33
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:WI
Practice Address - Zip Code:53923-9719
Practice Address - Country:US
Practice Address - Phone:608-330-1755
Practice Address - Fax:920-338-6869
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
WI259862163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN