Provider Demographics
NPI:1477528420
Name:COHEN, TERRI RAE GREENBERG (NMNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:RAE GREENBERG
Last Name:COHEN
Suffix:
Gender:F
Credentials:NMNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 SE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4911
Mailing Address - Country:US
Mailing Address - Phone:503-234-2584
Mailing Address - Fax:
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-5176
Practice Address - Fax:503-413-5222
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078040080N5 NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212905Medicaid
OR130264Medicare ID - Type Unspecified
OR212905Medicaid