Basic Information
| Provider Information | |||||||||
| NPI: | 1922347632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUGHLIN | ||||||||
| FirstName: | MARIE ANTOINETTE | ||||||||
| MiddleName: | PARAISO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COUGHLIN | ||||||||
| OtherFirstName: | TONI | ||||||||
| OtherMiddleName: | PARAISO | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 454 BROADWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814858222 | ||||||||
| FaxNumber: | 7814858220 | ||||||||
| Practice Location | |||||||||
| Address1: | 454 BROADWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814858222 | ||||||||
| FaxNumber: | 7814858220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2013 | ||||||||
| LastUpdateDate: | 02/01/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 214520 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.