Provider Demographics
NPI:1538307715
Name:COHEN, DEBRA T (RN,PNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:T
Last Name:COHEN
Suffix:
Gender:F
Credentials:RN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2334
Mailing Address - Country:US
Mailing Address - Phone:617-965-0315
Mailing Address - Fax:
Practice Address - Street 1:79 WARREN ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2334
Practice Address - Country:US
Practice Address - Phone:617-965-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94396364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics