Healthcare Provider Details

I. General information

NPI: 1548086143
Provider Name (Legal Business Name): YOLONDRA RACHELLE COCHRAN NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 680213
CHARLOTTE NC
28216-0004
US

IV. Provider business mailing address

PO BOX 680213
CHARLOTTE NC
28216-0004
US

V. Phone/Fax

Practice location:
  • Phone: 704-891-7025
  • Fax:
Mailing address:
  • Phone: 704-891-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number217150
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number217150
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number217150
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number217150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: