Healthcare Provider Details

I. General information

NPI: 1174504047
Provider Name (Legal Business Name): ELAINE MALVINA COOK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE MALVINA HUFF CRNP

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 RIDGELYS CHOICE DR
NOTTINGHAM MD
21236-3026
US

IV. Provider business mailing address

3813 SALEM CHURCH RD
JARRETTSVILLE MD
21084-1414
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-8009
  • Fax: 410-766-8028
Mailing address:
  • Phone: 410-692-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR063214
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR063214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: