Healthcare Provider Details

I. General information

NPI: 1063683183
Provider Name (Legal Business Name): MELISSA JANE COHEN RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

22 S. MAIN ST
SMYRNA, DE DE
19977
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-4737
  • Fax:
Mailing address:
  • Phone: 302-653-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0030993
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: