Provider Demographics
NPI:1063240547
Name:COCHRAN, ANDRE (EMT-B)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 WILLOWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1748
Mailing Address - Country:US
Mailing Address - Phone:419-989-2526
Mailing Address - Fax:
Practice Address - Street 1:833 WILLOWOOD DR W
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1748
Practice Address - Country:US
Practice Address - Phone:419-989-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker