Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3612 | LA |
NPI | 1023183894 |
---|---|
Provider Name | Mrs. Cheryl Gwyn Cottrell |
First Address | West Monroe, LA 71294-2235 |
Second Address | West Monroe, LA 71291-7508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |