Provider Demographics
NPI:1639514565
Name:COUGLER, ERNIE S (NP)
Entity type:Individual
Prefix:MR
First Name:ERNIE
Middle Name:S
Last Name:COUGLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WEST BARNEY ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642
Mailing Address - Country:US
Mailing Address - Phone:315-287-4440
Mailing Address - Fax:315-287-1858
Practice Address - Street 1:7016 COUNTY ROUTE 10
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:NY
Practice Address - Zip Code:13658
Practice Address - Country:US
Practice Address - Phone:315-393-3227
Practice Address - Fax:315-393-1322
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY364451163W00000X
NY337996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse