Provider Demographics
NPI:1720305782
Name:COCHRAN, JEANETTE (NP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
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 1:416 E MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:260-667-5131
Mailing Address - Fax:260-665-7803
Practice Address - Street 1:301 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2012
Practice Address - Country:US
Practice Address - Phone:260-667-5635
Practice Address - Fax:260-665-8852
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003238A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000667680OtherANTHEM
IN000000667680OtherANTHEM