Healthcare Provider Details

I. General information

NPI: 1720305782
Provider Name (Legal Business Name): JEANETTE COCHRAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 03/07/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAUMEE ST
ANGOLA IN
46703-2012
US

IV. Provider business mailing address

416 E MAUMEE ST
ANGOLA IN
46703-2015
US

V. Phone/Fax

Practice location:
  • Phone: 260-667-5635
  • Fax: 260-665-8852
Mailing address:
  • Phone: 260-667-5131
  • Fax: 260-665-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: