Healthcare Provider Details

I. General information

NPI: 1467907394
Provider Name (Legal Business Name): CYNTHIA ANN COENEN ARNP/PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2016
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 MERLE HAY RD STE 106
DES MOINES IA
50322-1983
US

IV. Provider business mailing address

4725 MERLE HAY RD STE 106
DES MOINES IA
50322-1983
US

V. Phone/Fax

Practice location:
  • Phone: 515-478-9502
  • Fax: 833-973-4175
Mailing address:
  • Phone: 515-478-9502
  • Fax: 833-973-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG064460
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG064460
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: