Healthcare Provider Details

I. General information

NPI: 1811955016
Provider Name (Legal Business Name): AUTUMN B COHEN CNMW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST 7TH FLOOR
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

1500 MARKET ST 24TH FLOOR WEST TOWER
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7824
  • Fax: 215-246-5257
Mailing address:
  • Phone: 215-255-3529
  • Fax: 215-832-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: