Provider Demographics
NPI:1770545568
Name:KOTTLER, NINA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ELLEN
Last Name:KOTTLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:601 FRONT AVENUE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-415-0524
Mailing Address - Fax:208-763-3644
Practice Address - Street 1:601 FRONT AVENUE
Practice Address - Street 2:SUITE 502
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-415-0524
Practice Address - Fax:208-763-3644
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM93242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology