Provider Demographics
NPI:1689976300
Name:KOCHAKIAN, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:KOCHAKIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 PATRICKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04348-3035
Mailing Address - Country:US
Mailing Address - Phone:207-549-5950
Mailing Address - Fax:
Practice Address - Street 1:649 PATRICKTOWN RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04348-3035
Practice Address - Country:US
Practice Address - Phone:207-549-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide