Healthcare Provider Details

I. General information

NPI: 1003409244
Provider Name (Legal Business Name): TONYA ALAE COOK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 08/01/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 BELAIR RD # 1026
BALTIMORE MD
21206-2607
US

IV. Provider business mailing address

5808 BELAIR RD # 1026
BALTIMORE MD
21206-2607
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-3082
  • Fax:
Mailing address:
  • Phone: 443-854-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR182700
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR182700
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: