Healthcare Provider Details

I. General information

NPI: 1639497860
Provider Name (Legal Business Name): ERIN E. COOK AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN BODNAR AA

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33300 CLEVELAND CLINIC BLVD
AVON OH
44011-1172
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-5000
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: