Healthcare Provider Details

I. General information

NPI: 1255362794
Provider Name (Legal Business Name): HEATHER J COOK-SMITH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PORTLAND AVE
ROCHESTER NY
14621-3065
US

IV. Provider business mailing address

2021 WINTON RD S
ROCHESTER NY
14618-3957
US

V. Phone/Fax

Practice location:
  • Phone: 585-697-6416
  • Fax: 585-444-3280
Mailing address:
  • Phone: 585-784-6400
  • Fax: 585-341-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: