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General NPI Number Information
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NPI Number | 1942738398
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Entity Type | Individual
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Provider Name | JENA M COTTRELL FNP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 1813 W HARVARD AVE STE 241
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City | ROSEBURG
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State | OR
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Zip | 97471-8708
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Country | US
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Telephone | 541-229-7038
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Fax | 541-464-4474
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Provider Business Mailing Address
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Address Line | PO BOX 1700
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City | ROSEBURG
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State | OR
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Zip | 97470-0414
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Country | US
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Telephone | 541-229-7038
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Fax | 541-464-4474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201703857NP-PP
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License Number State | OR
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