Provider Demographics
NPI:1841505633
Name:COCHRAN ABRAHAM, MARY MARGARET (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:COCHRAN ABRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 942895
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:94295-0001
Mailing Address - Country:US
Mailing Address - Phone:916-653-0090
Mailing Address - Fax:916-653-1795
Practice Address - Street 1:220 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1412
Practice Address - Country:US
Practice Address - Phone:707-944-4716
Practice Address - Fax:707-944-5052
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA706676163W00000X
CA19976363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse