Provider Demographics
NPI:1730116732
Name:COCHRAN, GABRIELLE W (NP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:W
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CASS STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48684-4156
Mailing Address - Country:US
Mailing Address - Phone:231-947-2270
Mailing Address - Fax:231-947-1284
Practice Address - Street 1:1515 CASS STREET SUITE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4156
Practice Address - Country:US
Practice Address - Phone:231-947-2270
Practice Address - Fax:231-947-1284
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704137581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS99275Medicare UPIN