Provider Demographics
NPI:1285656132
Name:FLEMING COHEN, KATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FLEMING COHEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:KATHERINE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4623 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4542
Mailing Address - Country:US
Mailing Address - Phone:215-474-6100
Mailing Address - Fax:
Practice Address - Street 1:4623 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4542
Practice Address - Country:US
Practice Address - Phone:215-474-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001255B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S97966Medicare UPIN