Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 16782 | CA |
NPI | 1033391552 |
---|---|
Provider Name | Ms. Susanna Rose Cohen |
First Address | Salt Lake City, UT 84112-5880 |
Second Address | Salt Lake City, UT 84112-5880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 12/11/2021 |