Individual
MRS. TABATHA IRENE COGHLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
S.T.N.A
Contact information
Practice address
2119 MIDDLE AVE, ELYRIA, OH 44035-7878
(440) 310-1352
Mailing address
2119 MIDDLE AVE, ELYRIA, OH 44035-7878
(440) 310-1352
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
400263440703
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2862540
—
OH
Enumeration date
03/16/2009
Last updated
03/16/2009
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