Provider Demographics
NPI:1396998357
Name:COTTRELL, LISA MARIE (CNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLTOP VLG
Mailing Address - Street 2:P.O. BOX 31
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-8147
Mailing Address - Country:US
Mailing Address - Phone:304-376-6523
Mailing Address - Fax:
Practice Address - Street 1:500 LEON SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1217
Practice Address - Country:US
Practice Address - Phone:304-556-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9906290376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide