Provider Demographics
NPI:1710193768
Name:COCHRAN, MYCHELLE LYNNETTE (NURSE)
Entity Type:Individual
Prefix:MS
First Name:MYCHELLE
Middle Name:LYNNETTE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-7753
Mailing Address - Country:US
Mailing Address - Phone:856-364-9317
Mailing Address - Fax:856-447-5142
Practice Address - Street 1:3121 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-7753
Practice Address - Country:US
Practice Address - Phone:856-364-9317
Practice Address - Fax:856-447-5142
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05207600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse