1164162467 NPI number — CAROL COTTINGHAM NINO

Table of content: CAROL COTTINGHAM NINO (NPI 1164162467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164162467 NPI number — CAROL COTTINGHAM NINO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NINO
Provider First Name:
CAROL
Provider Middle Name:
COTTINGHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164162467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 MANCHESTER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLEYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19438-3619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-692-3132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARMINSTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18974-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-956-2834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP029879L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RP029879L . This is a "RPH LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RPI014560 . This is a "IMMUNATION LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".