Healthcare Provider Details

I. General information

NPI: 1962405100
Provider Name (Legal Business Name): ELAINE K COCHRAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NIH NIDDK DEOB 10 CENTER DRIVE CRC 6 5940
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

12007 TITIAN WAY
POTOMAC MD
20854-3345
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-2718
  • Fax: 301-480-3368
Mailing address:
  • Phone: 240-753-9065
  • Fax: 301-480-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR119905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: