1639791981 NPI number — ALEXANDREA BEATRICE COCHRAN PA-C

Table of content: ALEXANDREA BEATRICE COCHRAN PA-C (NPI 1639791981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639791981 NPI number — ALEXANDREA BEATRICE COCHRAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCHRAN
Provider First Name:
ALEXANDREA
Provider Middle Name:
BEATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639791981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20014 TWIN POND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSTOWN TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-221-1553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26346 GIBRALTAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLAT ROCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48134-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-535-8977
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 5601010840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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