Healthcare Provider Details

I. General information

NPI: 1619298437
Provider Name (Legal Business Name): RENA I COCHRAN CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENA I WICKERT

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801-0160
US

IV. Provider business mailing address

PO BOX 160
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-966-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberOOOOO8348CNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: