=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639718075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL ANDREW COHEN FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2020
-----------------------------------------------------
Last Update Date | 08/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1392 LOWRIE AVE
-----------------------------------------------------
City | SOUTH SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94080-6402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-646-5474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 HOWARD ST # 811
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94105-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 628-217-1138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP95013143
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------