Provider Demographics
NPI:1659655348
Name:COHENS, KIMBERLY ELAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:COHENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1004
Mailing Address - Country:US
Mailing Address - Phone:585-512-6697
Mailing Address - Fax:
Practice Address - Street 1:402 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1004
Practice Address - Country:US
Practice Address - Phone:585-512-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278202-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse