Provider Demographics
NPI:1942363338
Name:COTHRAN, MARY MCCAA (PHD, CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MCCAA
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:PHD, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PEERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2214
Mailing Address - Country:US
Mailing Address - Phone:412-344-8489
Mailing Address - Fax:
Practice Address - Street 1:6001 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2574
Practice Address - Country:US
Practice Address - Phone:412-397-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001111B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily