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NPI Code Detail

MEDICARE: JACLYN R COCHRANE PA-C

MEDICARE: JACLYN R COCHRANE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant5601005220MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11881695484OTHERMICLINI'S NPI
25601005220OTHERMISTATE LICENSE

General Provider Information

NPI Number : 1053560045
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN R COCHRANE PA-C
Provider Business Mailing Address
First Line : 3700 52ND ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9637
Country : US
Telephone Number : 616-656-3700
Fax Number : 616-656-3701
Provider Business Practice Location Address
First Line : 3700 52ND ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9637
Country : US
Telephone Number : 616-656-3700
Fax Number : 616-656-3701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2008
Last Update Date : 12/17/2008

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Directions to “ JACLYN R COCHRANE PA-C” Practice Location

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