Provider Demographics
NPI:1891385001
Name:COTTRELL, NICOLE JEAN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEAN
Last Name:COTTRELL
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 1:248 BURNS FORK RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:WV
Mailing Address - Zip Code:26636-7578
Mailing Address - Country:US
Mailing Address - Phone:304-364-8272
Mailing Address - Fax:
Practice Address - Street 1:248 BURNS FORK RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:WV
Practice Address - Zip Code:26636-7578
Practice Address - Country:US
Practice Address - Phone:304-364-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant