Healthcare Provider Details

I. General information

NPI: 1124497995
Provider Name (Legal Business Name): MICHELLE M COHEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HIGHLAND AVE
WASHINGTON PA
15301-4062
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-1067
  • Fax: 724-223-1088
Mailing address:
  • Phone: 724-632-6801
  • Fax: 724-632-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015236
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP023180
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: