Healthcare Provider Details

I. General information

NPI: 1538271580
Provider Name (Legal Business Name): LYNETTE COOK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S 3RD AVE
PHOENIX AZ
85003-2614
US

IV. Provider business mailing address

3618 W PEORIA AVE
PHOENIX AZ
85029-4038
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-3904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN053557
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: