Provider Demographics
NPI:1013947894
Name:COTTRILL, LISA MICHELE (NURSE PRACTITIONER C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELE
Last Name:COTTRILL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER C
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Mailing Address - Street 1:921 MINERAL RD
Mailing Address - Street 2:# 101
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1342
Mailing Address - Country:US
Mailing Address - Phone:304-364-1093
Mailing Address - Fax:304-364-1050
Practice Address - Street 1:921 MINERAL RD
Practice Address - Street 2:STE 101
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1342
Practice Address - Country:US
Practice Address - Phone:304-364-1093
Practice Address - Fax:304-364-1050
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV33513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP52631Medicare UPIN