Provider Demographics
NPI:1215986740
Name:COUGHLIN, JESSE (RN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WEBSTER ST
Mailing Address - Street 2:2
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:641 W MAIN ST
Practice Address - Street 2:313
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2690
Practice Address - Country:US
Practice Address - Phone:608-259-6712
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health