Provider Demographics
NPI:1538795240
Name:COCHRAN, STEPHANY AMANDA (ASCP(CM))
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:AMANDA
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ASCP(CM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9085
Mailing Address - Country:US
Mailing Address - Phone:319-899-9239
Mailing Address - Fax:
Practice Address - Street 1:930 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9085
Practice Address - Country:US
Practice Address - Phone:319-899-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2541948207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2541948OtherASCP