Provider Demographics
NPI:1114600624
Name:COTNOIR, MALARY MAUDE (PA)
Entity Type:Individual
Prefix:
First Name:MALARY
Middle Name:MAUDE
Last Name:COTNOIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:419 S WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2951
Mailing Address - Country:US
Mailing Address - Phone:307-265-1620
Mailing Address - Fax:
Practice Address - Street 1:419 S WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2951
Practice Address - Country:US
Practice Address - Phone:307-265-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant