Healthcare Provider Details

I. General information

NPI: 1689186017
Provider Name (Legal Business Name): MARY VICTORIA COTHREN BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

311 PENNWOOD AVE # 1
PITTSBURGH PA
15221-3361
US

V. Phone/Fax

Practice location:
  • Phone: 412-864-8572
  • Fax:
Mailing address:
  • Phone: 412-897-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN688555
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: