Healthcare Provider Details

I. General information

NPI: 1295068708
Provider Name (Legal Business Name): SANDRA MARIE COOK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 GOLDFIELD PL NE
ALBUQUERQUE NM
87111-8208
US

IV. Provider business mailing address

6215 GOLDFIELD PL NE
ALBUQUERQUE NM
87111-8208
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-2686
  • Fax:
Mailing address:
  • Phone: 505-508-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR49396
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: