Provider Demographics
NPI:1134111321
Name:COCKSON, NANCY BETH (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:COCKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:952-926-7385
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-926-2300
Practice Address - Fax:952-926-7385
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA3181022469OtherPREFERRED ONE
MN15062COOtherBLUE CROSS BLUE SHIELD MN
MN966406OtherAMERICAS PPO/ARAZ
MN557388200Medicaid
MN55435A004OtherTRICARE
MN9221868OtherDAKOTA CARE
MN110134748OtherRAILROAD MEDICARE
MN0415431OtherMEDICA
MN55435A004OtherTRICARE
MN55435A004OtherTRICARE
MN411798069OtherEIN