Individual
JUDITH BLACKMAN-COCKRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Mailing address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
001870
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004238235
—
CT
01
—
101870
CONNECTICARE
—
01
—
2V4030
HEALTH NET
—
Enumeration date
11/13/2006
Last updated
07/08/2007
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