Provider Demographics
NPI:1033193578
Name:COTTRELL, DEANNA LYN (PAC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYN
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 WELLONS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5247
Mailing Address - Country:US
Mailing Address - Phone:252-634-9000
Mailing Address - Fax:252-634-9001
Practice Address - Street 1:3100 WELLONS BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5247
Practice Address - Country:US
Practice Address - Phone:252-634-9000
Practice Address - Fax:252-634-9001
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2761615Medicare PIN
S29894Medicare UPIN
NC2761615AMedicare PIN
NCP01206119Medicare PIN
NCP00172957Medicare PIN