MEDICARE: SUSAN GAIL COHEN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1010021887	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	319096	OTHER		MVP
3	10002929	OTHER		CDPHP
4	0029207	OTHER	VT	BC/BS

General Provider Information

NPI Number	:	1851391205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN GAIL COHEN CRNP

Provider Business Mailing Address
First Line	:	209 WASHINGTON AVE
Second Line	:
City	:	BENNINGTON
State	:	VT
Zip	:	05201-2312
Country	:	US
Telephone Number	:	802-442-0158
Fax Number	:	802-442-0160

Provider Business Practice Location Address
First Line	:	209 WASHINGTON AVE
Second Line	:
City	:	BENNINGTON
State	:	VT
Zip	:	05201-2312
Country	:	US
Telephone Number	:	802-442-0158
Fax Number	:	802-442-0160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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