Healthcare Provider Details

I. General information

NPI: 1710042122
Provider Name (Legal Business Name): ANDREA D COTHERN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BLVD SUITE 200
BATON ROUGE LA
70806-3726
US

IV. Provider business mailing address

9001 SUMMA AVENUE
BATON ROUGE LA
70809-3726
US

V. Phone/Fax

Practice location:
  • Phone: 225-336-3100
  • Fax: 225-336-3114
Mailing address:
  • Phone: 225-761-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberAP04318
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: