Provider Demographics
NPI:1750115036
Name:COCHRAN, ELLEN RAE (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:RAE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19569 PINE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-5146
Mailing Address - Country:US
Mailing Address - Phone:218-360-9466
Mailing Address - Fax:
Practice Address - Street 1:28 NW 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2714
Practice Address - Country:US
Practice Address - Phone:218-999-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12029363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health