=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881512630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MACKENZIE COCHRAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29921 LAKE CREEK RD
-----------------------------------------------------
City | COCHRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16314-8009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-333-5433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29921 LAKE CREEK RD
-----------------------------------------------------
City | COCHRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16314-8009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN776393
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------