Provider Demographics
NPI:1801302765
Name:COOGAN, ALYSSA (DCNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COOGAN
Suffix:
Gender:F
Credentials:DCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 FAUNCE CORNER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-6250
Mailing Address - Country:US
Mailing Address - Phone:508-985-5285
Mailing Address - Fax:401-239-1801
Practice Address - Street 1:368 FAUNCE CORNER RD STE 2
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-6250
Practice Address - Country:US
Practice Address - Phone:508-998-1994
Practice Address - Fax:508-998-5781
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAPRN01736OtherMEDICAL LICENSE