Provider Demographics
NPI:1619915261
Name:COTTRELL, SONYA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:A
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2188
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:253-845-7073
Practice Address - Street 1:10004 204TH AVE E
Practice Address - Street 2:# 3400
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6539
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-845-7073
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004726363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00220748OtherMEDICARE RAIL ROAD
WA3908COOtherREGENCE RIDER
WA8410540Medicaid
WA0192968OtherLABOR AND INDUSTRIES
WAP00220748OtherMEDICARE RAIL ROAD
WA0192968OtherLABOR AND INDUSTRIES