Individual
JACQUELINE RENEE COGHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
WATERFRONT RECOVERY SERVICES, 2413 2ND ST, EUREKA, CA 95501
(707) 269-9590
(707) 445-2599
Mailing address
3126 J ST, EUREKA, CA 95503-5416
(707) 599-6736
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95012163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417307125
MEDICAL DOCTOR
CA
Enumeration date
09/20/2019
Last updated
09/20/2019
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