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Individual

JACLYN R COCHRANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3700 52ND ST SE, GRAND RAPIDS, MI 49512-9637
(616) 656-3700
(616) 656-3701
Mailing address
3700 52ND ST SE, GRAND RAPIDS, MI 49512-9637
(616) 656-3700
(616) 656-3701

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005220
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1881695484
CLINI'S NPI
MI
01
5601005220
STATE LICENSE
MI
Enumeration date
09/15/2008
Last updated
12/17/2008
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