Provider Demographics
NPI:1003254988
Name:COCHRAN, CORDELIA RUTH (ARNP)
Entity Type:Individual
Prefix:DR
First Name:CORDELIA
Middle Name:RUTH
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST STE C2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2490
Mailing Address - Country:US
Mailing Address - Phone:253-383-0101
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:1919 N PEARL ST STE C2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2490
Practice Address - Country:US
Practice Address - Phone:253-383-0101
Practice Address - Fax:253-383-0419
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
WARN61093671163W00000X
WAAP61477497363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse