Provider Demographics
NPI:1205346079
Name:COTTRELL, SUSAN ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-695-8346
Mailing Address - Fax:301-624-5837
Practice Address - Street 1:77 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE E
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-695-8346
Practice Address - Fax:301-624-5837
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner