Provider Demographics
NPI:1689492357
Name:COUGHLIN, CIERRA MONET (NP)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:MONET
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 NEW YORK AVE NW APT 701
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4752
Mailing Address - Country:US
Mailing Address - Phone:202-255-5529
Mailing Address - Fax:
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3816
Practice Address - Country:US
Practice Address - Phone:240-599-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR268206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily