MEDICARE: DEANNA LYN COTTRELL PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	103681	NC

General Provider Information

NPI Number	:	1033193578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LYN COTTRELL PAC

Provider Business Mailing Address
First Line	:	3100 WELLONS BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5247
Country	:	US
Telephone Number	:	252-634-9000
Fax Number	:	252-634-9001

Provider Business Practice Location Address
First Line	:	3100 WELLONS BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5247
Country	:	US
Telephone Number	:	252-634-9000
Fax Number	:	252-634-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	02/08/2017

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Directions to “ DEANNA LYN COTTRELL PAC” Practice Location

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