MEDICARE: ANDREA D COTHERN NP

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	163WG0000X	General Practice Registered Nurse	AP04318	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710042122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA D COTHERN NP

Provider Business Mailing Address
First Line	:	9001 SUMMA AVENUE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3726
Country	:	US
Telephone Number	:	225-761-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 NORTH BLVD
Second Line	:	SUITE 200
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3726
Country	:	US
Telephone Number	:	225-336-3100
Fax Number	:	225-336-3114

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	12/20/2007

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