Provider Demographics
NPI:1386846509
Name:COCHRANE, NICCOLE (LMP)
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 RIDDELL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-7444
Mailing Address - Country:US
Mailing Address - Phone:253-333-2375
Mailing Address - Fax:
Practice Address - Street 1:402 E MAIN ST STE 160
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5550
Practice Address - Country:US
Practice Address - Phone:253-333-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist