Healthcare Provider Details

I. General information

NPI: 1639314719
Provider Name (Legal Business Name): NANCY ELIZABETH COOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 N CALIFORNIA BLVD SUITE 300
WALNUT CREEK CA
94596
UM

IV. Provider business mailing address

120 ALLEN WAY
PLEASANT HILL CA
94523-3218
US

V. Phone/Fax

Practice location:
  • Phone: 502-417-4344
  • Fax:
Mailing address:
  • Phone: 502-417-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: