Provider Demographics
NPI:1710176623
Name:COUGHLAN, CLAIRE M (NP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:M
Last Name:COUGHLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1345 PLAZA COURT N.
Mailing Address - Street 2:#1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2832
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-604-6243
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:303-604-6243
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005431-NP363L00000X
CO165824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13404709Medicaid
C811329Medicare PIN