MEDICARE: MRS. ALEXIYAH ROSE COUGHLIN APNP, WHNP-BC, IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	259862	WI
2	174N00000X	Lactation Consultant (Non-RN)
3	363LW0102X	Women's Health Nurse Practitioner	16436-33	WI

General Provider Information

NPI Number	:	1699204719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXIYAH ROSE COUGHLIN APNP, WHNP-BC, IBCLC

Provider Business Mailing Address
First Line	:	W3980 STATE ROAD 33
Second Line	:
City	:	CAMBRIA
State	:	WI
Zip	:	53923-9719
Country	:	US
Telephone Number	:	608-330-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 WINDSOR ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2023
Country	:	US
Telephone Number	:	414-249-4420
Fax Number	:	844-222-7213

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	02/01/2025

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