Healthcare Provider Details

I. General information

NPI: 1356347116
Provider Name (Legal Business Name): BRUCE W. COOK C.R.N.A
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E HOLME ST
NORTON KS
67654-1406
US

IV. Provider business mailing address

PO BOX 250
NORTON KS
67654-0250
US

V. Phone/Fax

Practice location:
  • Phone: 785-877-3351
  • Fax: 785-877-2841
Mailing address:
  • Phone: 785-877-3351
  • Fax: 785-877-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54992
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: