Blackman-Cockran, Judith

Blackman-Cockran, Judith is an individual health care provider with primary practice located at 495 Gold Star Hwy Suite 120, Groton CT 06340-6228. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Blackman-Cockran, Judith can be contacted via phone (860) 449-8882.

Contact Information

Primary practice address
495 Gold Star Hwy Suite 120 Groton CT 06340-6228
Phone: (860) 449-8882
Fax: (860) 449-9195
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 001870 Connecticut

Profile Details

NPI number 1548331390
LBN Legal business name Blackman-Cockran, Judith
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548331390 NPPES
Other 2V4030 HEALTH NET
Other 101870 HEALTH NET
MEDICAID 004238235 HEALTH NET

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