Provider Demographics
NPI:1265664189
Name:COTTRELL, NICOLE ELEANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELEANOR
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:ELEANOR
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-552-0400
Mailing Address - Fax:405-752-4251
Practice Address - Street 1:10900 HEFNER POINTE DR STE 505
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5006
Practice Address - Country:US
Practice Address - Phone:405-552-0400
Practice Address - Fax:405-752-4251
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38365208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery