Provider Demographics
NPI:1376880468
Name:COTHRAN, SHARON S (ADN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:S
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:LA FRANCE
Mailing Address - State:SC
Mailing Address - Zip Code:29656-0487
Mailing Address - Country:US
Mailing Address - Phone:864-403-2308
Mailing Address - Fax:864-646-8011
Practice Address - Street 1:315 E QUEEN ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-1721
Practice Address - Country:US
Practice Address - Phone:864-403-2308
Practice Address - Fax:864-646-8011
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942275649Medicaid