Provider Demographics
NPI:1164008652
Name:COTTRELL, JOYCE J (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:J
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 BRIGHT PLUME
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3749
Mailing Address - Country:US
Mailing Address - Phone:240-490-0302
Mailing Address - Fax:
Practice Address - Street 1:15912 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1324
Practice Address - Country:US
Practice Address - Phone:240-490-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4797163WH0200X
MDR196084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health