Provider Demographics
NPI:1609476423
Name:COCHRAN, JUANITA IREAN
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:IREAN
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 1:364 MCDANIEL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-5902
Mailing Address - Country:US
Mailing Address - Phone:304-661-4826
Mailing Address - Fax:
Practice Address - Street 1:364 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-5902
Practice Address - Country:US
Practice Address - Phone:304-661-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant