Individual
MRS. MARISA COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10001679A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001063420
ANTHEM PROVIDER PIN
IN
05
—
300008932
—
IN
Enumeration date
07/14/2014
Last updated
02/01/2021
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