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General NPI Number Information
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NPI Number | 1750069258
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Entity Type | Individual
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Provider Name | MARY ANN COGHLAN APRN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1526 LEANDER RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8801
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Country | US
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Telephone | 512-863-7586
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Fax |
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Provider Business Mailing Address
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Address Line | 137 JOSEY WALES DR
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City | JARRELL
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State | TX
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Zip | 76537-0730
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Country | US
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Telephone | 469-531-2721
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1127035
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License Number State | TX
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