Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125.070795 | IL |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 11730992-1204 | UT |
NPI | 1114457413 |
---|---|
Provider Name | Adrienne Cohen |
First Address | Salt Lake City, UT 84132-1287 |
Second Address | Salt Lake City, UT 84132-1287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125.070795 | IDFPR (01) | IL |