Healthcare Provider Details

I. General information

NPI: 1629281043
Provider Name (Legal Business Name): MARSHA LESLIE COHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 INTERNATIONAL LN
MADISON WI
53704-3135
US

IV. Provider business mailing address

5010 WOODBURN DR
MADISON WI
53711-1115
US

V. Phone/Fax

Practice location:
  • Phone: 608-245-3052
  • Fax: 608-245-3585
Mailing address:
  • Phone: 608-245-3052
  • Fax: 608-245-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number810-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: