Healthcare Provider Details

I. General information

NPI: 1477308963
Provider Name (Legal Business Name): KRISTEN L COTTON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 BOUGHTON ST APT 6H
WATERTOWN WI
53094-3127
US

IV. Provider business mailing address

1153 BOUGHTON ST APT 6H
WATERTOWN WI
53094-3127
US

V. Phone/Fax

Practice location:
  • Phone: 262-722-3908
  • Fax:
Mailing address:
  • Phone: 262-722-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number366275
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: