Individual
MRS. MARYELLEN M COTELLESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 LAMB CIR STE 335, CHRISTIANSBURG, VA 24073-6341
(540) 633-5650
(540) 633-1524
Mailing address
PO BOX 1364, RADFORD, VA 24143-1364
(540) 633-5650
(540) 633-1524
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
0024090106
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7794126
—
VA
Enumeration date
04/09/2007
Last updated
07/08/2007
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