MEDICARE: MS. SONYA A COTTRELL PA-C

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	363AM0700X	Medical Physician Assistant	PA10004726	WA
2	363A00000X	Physician Assistant	PA10004726	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00220748	OTHER	WA	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3908CO	OTHER	WA	REGENCE RIDER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0192968	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1619915261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONYA A COTTRELL PA-C

Provider Business Mailing Address
First Line	:	3908 10TH ST SE
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2188
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

Provider Business Practice Location Address
First Line	:	10004 204TH AVE E
Second Line	:	# 3400
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6539
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/25/2016

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