Provider Demographics
NPI:1710424205
Name:COUGHLIN, RACHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-235-6565
Mailing Address - Fax:856-235-6566
Practice Address - Street 1:707 WHITE HORSE RD STE C103
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:844-542-2273
Practice Address - Fax:856-384-0218
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00688900363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
562251ZGH1Medicare PIN