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General NPI Number Information
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NPI Number | 1710424205
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Entity Type | Individual
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Provider Name | RACHELLE COUGHLIN NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 707 WHITE HORSE RD STE C103
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City | VOORHEES
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State | NJ
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Zip | 08043-2461
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Country | US
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Telephone | 844-542-2273
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Fax | 856-384-0218
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Provider Business Mailing Address
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Address Line | 110 MARTER AVE STE 102
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3124
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Country | US
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Telephone | 856-235-6565
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Fax | 856-235-6566
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00688900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00688900
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License Number State | NJ
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