Provider Demographics
NPI:1518916022
Name:KOCHER, GLORIA J (CRNA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:KOCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3033
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3033
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-567-2191
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1948
Practice Address - Country:US
Practice Address - Phone:317-567-2180
Practice Address - Fax:317-567-2191
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28139326A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000479783OtherANTHEM PROVIDER NUMBER
IN11573406OtherCAQH NUMBER
IN9436026OtherPHCS PID NUMBER
IN200176990Medicaid
IN200176990Medicaid
IN815500D5Medicare PIN