MEDICARE: MS. JESSICA LEE COTTRELL LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	27051091A	IN

General Provider Information

NPI Number	:	1306039839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA LEE COTTRELL LPN

Provider Business Mailing Address
First Line	:	604 W BROADWAY ST
Second Line	:
City	:	ALEXANDRIA
State	:	IN
Zip	:	46001-1721
Country	:	US
Telephone Number	:	765-724-7517
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 W BROADWAY ST
Second Line	:
City	:	ALEXANDRIA
State	:	IN
Zip	:	46001-1721
Country	:	US
Telephone Number	:	765-724-7517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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