Provider Demographics
NPI:1871951194
Name:COTTON, GEORGIANNE KATHLEEN (PA)
Entity type:Individual
Prefix:
First Name:GEORGIANNE
Middle Name:KATHLEEN
Last Name:COTTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 29TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-444-6400
Mailing Address - Fax:303-444-6465
Practice Address - Street 1:2919 VALMONT RD STE 104
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-444-6400
Practice Address - Fax:303-444-6465
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53218363A00000X
COPA0004770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant