Provider Demographics
NPI:1851391205
Name:COHEN, SUSAN GAIL (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:COHEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2312
Mailing Address - Country:US
Mailing Address - Phone:802-442-0158
Mailing Address - Fax:802-442-0160
Practice Address - Street 1:209 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2312
Practice Address - Country:US
Practice Address - Phone:802-442-0158
Practice Address - Fax:802-442-0160
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010021887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP2167Medicaid
319096OtherMVP
10002929OtherCDPHP
VT0029207OtherBC/BS
VT0NP2167Medicaid