Provider Demographics
NPI:1740556836
Name:COTTER, WILLIAM ELLIOT (RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ELLIOT
Last Name:COTTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 SAGE RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5807
Mailing Address - Country:US
Mailing Address - Phone:210-488-4818
Mailing Address - Fax:
Practice Address - Street 1:1719 SAGE RUN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5807
Practice Address - Country:US
Practice Address - Phone:210-488-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX804629163W00000X
PARN322688L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse