MEDICARE: ROSE MADELYN COUGHLIN CNS

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	163W00000X	Registered Nurse	199456	OH

General Provider Information

NPI Number	:	1497912331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MADELYN COUGHLIN CNS

Provider Business Mailing Address
First Line	:	525 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44309-2090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44309-2090
Country	:	US
Telephone Number	:	330-375-4937
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/03/2010

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