Healthcare Provider Details

I. General information

NPI: 1992199210
Provider Name (Legal Business Name): HANNAH FRAYNE EMANUEL COOK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH FRAYNE COOK FNP

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD STE 3219
MERIDIAN ID
83642-6356
US

IV. Provider business mailing address

520 S EAGLE RD STE 3219
MERIDIAN ID
83642-6356
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-8715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1616A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0199705
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number50674
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: