Healthcare Provider Details

I. General information

NPI: 1720704257
Provider Name (Legal Business Name): DANIELLE NICOLE COHEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE NICOLE MARR

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

IV. Provider business mailing address

9 SYCAMORE LN
SWEDESBORO NJ
08085-3460
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 609-970-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberSP026221
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: