Provider Demographics
NPI:1578341855
Name:COTTINGHAM, AZLYNN DANAE
Entity Type:Individual
Prefix:
First Name:AZLYNN
Middle Name:DANAE
Last Name:COTTINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LEONARD AVENUE EXT APT 6H
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3874
Mailing Address - Country:US
Mailing Address - Phone:304-413-6925
Mailing Address - Fax:
Practice Address - Street 1:480 LEONARD AVENUE EXT APT 6H
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3874
Practice Address - Country:US
Practice Address - Phone:304-413-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant