Provider Demographics
NPI:1265734537
Name:COTTE, JEVONNIE D (RN)
Entity type:Individual
Prefix:
First Name:JEVONNIE
Middle Name:D
Last Name:COTTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25578 PACATO RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25578 PACATO RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1941
Practice Address - Country:US
Practice Address - Phone:951-662-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2020-08-14
Deactivation Date:2018-10-17
Deactivation Code:
Reactivation Date:2020-08-14
Provider Licenses
StateLicense IDTaxonomies
CA747109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse