Provider Demographics
NPI:1548608268
Name:COTHRAN, LAURA D B (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:D B
Last Name:COTHRAN
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 1:1225 CAVALIER WAY
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3366
Mailing Address - Country:US
Mailing Address - Phone:864-582-3479
Mailing Address - Fax:864-342-8997
Practice Address - Street 1:1225 CAVALIER WAY
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3366
Practice Address - Country:US
Practice Address - Phone:864-582-3479
Practice Address - Fax:864-342-8997
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP6225164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse