Maryellen M Cotellese

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

0024090106 Issued in VA

Practice address

2900 Lamb Cir Ste 335
Christiansburg, VA 24073-6341

Phone

(540) 633-5650

Fax

(540) 633-1524

NPI assigned

Apr 9, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518080191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1364",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241431364",
            "telephone_number": "540-633-5650",
            "fax_number": "540-633-1524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 LAMB CIR STE 335",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240736341",
            "telephone_number": "540-633-5650",
            "fax_number": "540-633-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTELLESE",
        "first_name": "MARYELLEN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VA",
            "license": "0024090106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7794126",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Christiansburg, VA
• Providers in Christiansburg, VA by specialty
• Primary Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.