Provider Demographics
NPI:1184665614
Name:COTTRILL, ANNETTE GLORINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:GLORINE
Last Name:COTTRILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 YALE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1934
Mailing Address - Country:US
Mailing Address - Phone:421-954-3003
Mailing Address - Fax:419-775-0038
Practice Address - Street 1:673 YALE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1934
Practice Address - Country:US
Practice Address - Phone:421-954-3003
Practice Address - Fax:419-775-0038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN100412164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2294164Medicaid