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General NPI Number Information
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NPI Number | 1003142639
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Entity Type | Organization
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Legal Business Name | MARY ELAINE COOK
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 2145 SANTA CATALINA DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-3321
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Country | US
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Telephone | 520-458-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 SANTA CATALINA DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-3321
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Country | US
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Telephone | 520-458-1736
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Fax |
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Authorized Official
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Title or Position | RECURTOR
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Name | MR. JACKSON WEAVER
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Credential |
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Telephone | 480-345-6668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN138025
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN9218626
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License Number State | FL
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