Basic Information
| Provider Information | |||||||||
| NPI: | 1619180122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | CNM, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 SAN MATEO BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871081434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054850464 | ||||||||
| FaxNumber: | 5052661017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 W 72ND AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802212721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036504460 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 757 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 811910 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | APN.0003064-CNM | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 109680 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 19334061 | 05 | NM | MEDICAID | 900040284 | 05 | CO | MEDICAID |