Provider Demographics
NPI:1992043962
Name:COCHRAN, ALEXANDREA JOSEPHINE
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:JOSEPHINE
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 1:420 N HENRY ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1364
Mailing Address - Country:US
Mailing Address - Phone:419-617-6747
Mailing Address - Fax:
Practice Address - Street 1:420 N HENRY ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1364
Practice Address - Country:US
Practice Address - Phone:419-617-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401158121010374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide