Provider Demographics
NPI:1619180122
Name:COHEN, LINDA SUSAN (CNM, CNS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:COHEN
Suffix:
Gender:F
Credentials:CNM, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-485-0464
Mailing Address - Fax:505-266-1017
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM757367A00000X
NV811910367A00000X
COAPN.0003064-CNM367A00000X
CO109680367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19334061Medicaid
CO900040284Medicaid