Provider Demographics
NPI:1962777391
Name:COTTER, EILEEN MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARIE
Last Name:COTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1734
Mailing Address - Country:US
Mailing Address - Phone:914-552-6789
Mailing Address - Fax:
Practice Address - Street 1:1230 ZEREGA AVE
Practice Address - Street 2:ROOM 46
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5422
Practice Address - Country:US
Practice Address - Phone:718-828-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480011163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse