Provider Demographics
NPI:1023232758
Name:COTTRILL, DENTON DUANE (LPN)
Entity type:Individual
Prefix:MR
First Name:DENTON
Middle Name:DUANE
Last Name:COTTRILL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:DENNY
Other - Middle Name:DUANE
Other - Last Name:COTTRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:16 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1116
Mailing Address - Country:US
Mailing Address - Phone:330-872-1891
Mailing Address - Fax:
Practice Address - Street 1:16 GRANT ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1116
Practice Address - Country:US
Practice Address - Phone:330-872-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN92892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse