Provider Demographics
NPI:1053695437
Name:COHEN, DANA ROBERTS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ROBERTS
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARGARET
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2323 N. CENTRAL AVE UNIT 1705
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:651-783-4818
Mailing Address - Fax:480-718-1281
Practice Address - Street 1:1315 W. SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-718-1280
Practice Address - Fax:480-718-1281
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4917363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical