Provider Demographics
NPI:1306248885
Name:KOHN, SHOSHANA RACHEL (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:RACHEL
Last Name:KOHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:R
Other - Last Name:UNGAR-KOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 605
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-0495
Practice Address - Fax:248-551-7268
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273707363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily