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NPI Code Detail

MEDICARE: MRS. SHANNON VIRGINIA COOK RN, FNP-BC, WHNP

MEDICARE: MRS. SHANNON VIRGINIA COOK RN, FNP-BC, WHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WE0003XEmergency Registered Nurse28169430AIN
2363LF0000XFamily Nurse PractitionerRN1031235DC
3363LF0000XFamily Nurse Practitioner0024171259VA
4363LF0000XFamily Nurse Practitioner71006911AIN

General Provider Information

NPI Number : 1083924104
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON VIRGINIA COOK RN, FNP-BC, WHNP
Provider Business Mailing Address
First Line : 1545 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2306
Country : US
Telephone Number : 317-850-7158
Fax Number :
Provider Business Practice Location Address
First Line : 1545 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2306
Country : US
Telephone Number : 317-850-7158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2010
Last Update Date : 03/02/2017

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