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General NPI Number Information
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NPI Number | 1003759358
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Entity Type | Individual
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Provider Name | AMANDA NICHOLE COOK RN
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Gender | Female
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 3547 E BERETTA AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6415
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Country | US
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Telephone | 208-206-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 3547 E BERETTA AVE 3547 E BERETTA AVE # 83404
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6415
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Country | US
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Telephone | 208-206-9549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 47964
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License Number State | ID
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