Healthcare Provider Details

I. General information

NPI: 1477030427
Provider Name (Legal Business Name): SUSAN LYNN COCORES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CARSON ST
CARSON CITY NV
89706-0153
US

IV. Provider business mailing address

823 MAHOGANY DR
MINDEN NV
89423-4723
US

V. Phone/Fax

Practice location:
  • Phone: 910-330-2908
  • Fax:
Mailing address:
  • Phone: 910-330-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number811870
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: