Healthcare Provider Details

I. General information

NPI: 1952827834
Provider Name (Legal Business Name): CASSANDRA DAWN COOK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD, BLDG 17, 3RD FLOOR
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

PO BOX 9825
VANCOUVER WA
98666-8825
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8000
  • Fax: 360-397-8110
Mailing address:
  • Phone: 360-397-8000
  • Fax: 360-397-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00145583
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00145583
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: