Healthcare Provider Details

I. General information

NPI: 1124167119
Provider Name (Legal Business Name): PEGGY COHEN LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 SOUTH RD
WILLISTON VT
05495-8882
US

IV. Provider business mailing address

2907 SOUTH RD
WILLISTON VT
05495-8882
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-1115
  • Fax:
Mailing address:
  • Phone: 802-879-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1070000004
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-305240
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: