Provider Demographics
NPI:1922347632
Name:COUGHLIN, MARIE ANTOINETTE PARAISO (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE ANTOINETTE
Middle Name:PARAISO
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TONI
Other - Middle Name:PARAISO
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:454 BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3034
Mailing Address - Country:US
Mailing Address - Phone:781-485-8222
Mailing Address - Fax:781-485-8220
Practice Address - Street 1:454 BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3034
Practice Address - Country:US
Practice Address - Phone:781-485-8222
Practice Address - Fax:781-485-8220
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse