Provider Demographics
NPI:1760247290
Name:COTTON, CHARISSE LASHAUN
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:LASHAUN
Last Name:COTTON
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 1:6150 ENTERPRISE PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2755
Mailing Address - Country:US
Mailing Address - Phone:216-293-5107
Mailing Address - Fax:
Practice Address - Street 1:6150 ENTERPRISE PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2755
Practice Address - Country:US
Practice Address - Phone:216-293-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory