Healthcare Provider Details

I. General information

NPI: 1629439849
Provider Name (Legal Business Name): AMY COCHRAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

IV. Provider business mailing address

464 DIVEN LN
GAHANNA OH
43230-2709
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-4506
  • Fax: 614-291-0118
Mailing address:
  • Phone: 614-224-4506
  • Fax: 614-291-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN330625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: