Healthcare Provider Details

I. General information

NPI: 1134399405
Provider Name (Legal Business Name): LASHAWNA APRIL BRANDT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BAILEY AVE
WICHITA FALLS TX
76301-6927
US

IV. Provider business mailing address

121 DUNBAR DR
WICHITA FALLS TX
76302-3708
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-0279
  • Fax:
Mailing address:
  • Phone: 940-781-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number209365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: