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General NPI Number Information
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NPI Number | 1851391205
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Entity Type | Individual
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Provider Name | SUSAN GAIL COHEN CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 WASHINGTON AVE
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City | BENNINGTON
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State | VT
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Zip | 05201-2312
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Country | US
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Telephone | 802-442-0158
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Fax | 802-442-0160
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Provider Business Mailing Address
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Address Line | 209 WASHINGTON AVE
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City | BENNINGTON
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State | VT
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Zip | 05201-2312
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Country | US
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Telephone | 802-442-0158
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Fax | 802-442-0160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1010021887
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License Number State | VT
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