Provider Demographics
NPI:1013394469
Name:COCHRANE, TERESA (CN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11191 LONGWOOD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1313
Mailing Address - Country:US
Mailing Address - Phone:703-435-8193
Mailing Address - Fax:
Practice Address - Street 1:11191 LONGWOOD GROVE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1313
Practice Address - Country:US
Practice Address - Phone:703-435-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist