Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704258454 | MI |
NPI | 1013348283 |
---|---|
Provider Name | Michael Joseph Cochenour |
First Address | South Lyon, MI 48178-9229 |
Second Address | Detroit, MI 48201-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2013 |
Last Update Date | 12/12/2013 |