Provider Demographics
NPI:1083112593
Name:COCHRAN, GRETA
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 YOUNG HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KENNA
Mailing Address - State:WV
Mailing Address - Zip Code:25248
Mailing Address - Country:US
Mailing Address - Phone:304-532-5193
Mailing Address - Fax:
Practice Address - Street 1:1793 YOUNG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:KENNA
Practice Address - State:WV
Practice Address - Zip Code:25248
Practice Address - Country:US
Practice Address - Phone:304-532-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20033904000OtherPROVIDER ID