Provider Demographics
NPI:1124802814
Name:COUGHLAN, OONAGH CLAIRE
Entity type:Individual
Prefix:
First Name:OONAGH
Middle Name:CLAIRE
Last Name:COUGHLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 GASTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226
Mailing Address - Country:US
Mailing Address - Phone:682-375-6045
Mailing Address - Fax:
Practice Address - Street 1:2626 REAGAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3305
Practice Address - Country:US
Practice Address - Phone:682-375-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ8019390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program