Healthcare Provider Details

I. General information

NPI: 1780638825
Provider Name (Legal Business Name): CINDY COOK-MARTIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 FAIRWAY LN
DURHAM NC
27712-9453
US

IV. Provider business mailing address

3417 FAIRWAY LN
DURHAM NC
27712-9453
US

V. Phone/Fax

Practice location:
  • Phone: 919-479-7145
  • Fax: 919-620-8494
Mailing address:
  • Phone: 919-479-7145
  • Fax: 919-620-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number50639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: