Provider Demographics
NPI:1205521051
Name:COCKRHAM, GWENDOLYN (BSN,RN)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:COCKRHAM
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 GENTILLY BLVD UNIT 2124
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3872
Mailing Address - Country:US
Mailing Address - Phone:504-515-3556
Mailing Address - Fax:
Practice Address - Street 1:3157 GENTILLY BLVD UNIT 2124
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3872
Practice Address - Country:US
Practice Address - Phone:504-515-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA151989163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy