Provider Demographics
NPI:1164645735
Name:COTTON, CHERYL (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:COTTON
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 1:4261 MALTBY RD
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9755
Mailing Address - Country:US
Mailing Address - Phone:585-757-9388
Mailing Address - Fax:
Practice Address - Street 1:4261 MALTBY RD
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:NY
Practice Address - Zip Code:14058-9755
Practice Address - Country:US
Practice Address - Phone:585-757-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY437531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01648700Medicaid