Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN282980 | MA |
NPI | 1215482518 |
---|---|
Provider Name | Mr. Peter Calvin Cohn |
First Address | Fairhaven, MA 02719-5255 |
Second Address | New Bedford, MA 02740-3464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2016 |
Last Update Date | 21/04/2020 |