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General NPI Number Information
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NPI Number | 1699204719
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Entity Type | Individual
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Provider Name | ALEXIYAH ROSE COUGHLIN APNP, WHNP-BC, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 02/01/2025
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Provider Practice Location Address
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Address Line | 908 WINDSOR ST
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2023
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Country | US
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Telephone | 414-249-4420
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Fax | 844-222-7213
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Provider Business Mailing Address
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Address Line | W3980 STATE ROAD 33
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City | CAMBRIA
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State | WI
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Zip | 53923-9719
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Country | US
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Telephone | 608-330-1755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 259862
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 16436-33
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License Number State | WI
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