1487090627 NPI number — MRS. LISA DEVINE COUGHLIN NP

Table of content: MRS. LISA DEVINE COUGHLIN NP (NPI 1487090627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487090627 NPI number — MRS. LISA DEVINE COUGHLIN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
LISA
Provider Middle Name:
DEVINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEVINE
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487090627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 CHESTNUT STREET
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01199-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-794-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325B KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-387-4100
Provider Business Practice Location Address Fax Number:
413-387-4119
Provider Enumeration Date:
05/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN264995 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)