MEDICARE: MAURICE COUGHLAN ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	RN251340	MA
2	363L00000X	Nurse Practitioner	RN251340	MA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN251340	MA

General Provider Information

NPI Number	:	1164710547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICE COUGHLAN ACNP

Provider Business Mailing Address
First Line	:	PROVIDER ENROLLMENT 41 MALL ROAD
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01805-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 S BEDFORD ST
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5108
Country	:	US
Telephone Number	:	781-744-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	09/25/2025

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