Provider Demographics
NPI:1427288117
Name:COCHRAN, CAMILLE NICOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:NICOLE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-2134
Mailing Address - Country:US
Mailing Address - Phone:414-377-7085
Mailing Address - Fax:
Practice Address - Street 1:2724 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-2134
Practice Address - Country:US
Practice Address - Phone:414-377-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310610-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse