Healthcare Provider Details

I. General information

NPI: 1225617517
Provider Name (Legal Business Name): ANN MARIE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 4TH ST
TILLAMOOK OR
97141-3422
US

IV. Provider business mailing address

1302 4TH ST
TILLAMOOK OR
97141-3422
US

V. Phone/Fax

Practice location:
  • Phone: 707-954-8690
  • Fax:
Mailing address:
  • Phone: 707-954-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201503851RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: