Provider Demographics
NPI:1811572100
Name:COTTONWOOD, LOIS ANN
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:COTTONWOOD
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:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329-0297
Mailing Address - Country:US
Mailing Address - Phone:701-472-2315
Mailing Address - Fax:
Practice Address - Street 1:10034 BIA RD 25 APT 571
Practice Address - Street 2:
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329
Practice Address - Country:US
Practice Address - Phone:701-472-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant