Provider Demographics
NPI:1750638482
Name:COUGHLAN, CAROLYN M (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:COUGHLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:VIVEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:25 BUTTRICK RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3352
Mailing Address - Country:US
Mailing Address - Phone:603-437-1003
Mailing Address - Fax:603-421-0868
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282087363LP0200X
NH066702-23364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics