Provider Demographics
NPI:1437395050
Name:COTHERN, DIANNA (CSA)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:COTHERN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9637
Mailing Address - Country:US
Mailing Address - Phone:888-479-3596
Mailing Address - Fax:615-346-9258
Practice Address - Street 1:3619 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9637
Practice Address - Country:US
Practice Address - Phone:888-479-3596
Practice Address - Fax:615-346-9258
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant