Healthcare Provider Details

I. General information

NPI: 1720156235
Provider Name (Legal Business Name): STEVEN W COOK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY ST
EVANSVILLE IN
47710-1674
US

IV. Provider business mailing address

PO BOX 3366
EVANSVILLE IN
47732-3366
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-3044
  • Fax: 812-450-2710
Mailing address:
  • Phone: 812-450-3044
  • Fax: 812-450-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1970202
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28105539A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: