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General NPI Number Information
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NPI Number | 1023557485
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Entity Type | Organization
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Legal Business Name | COOKE'S CONTINENCE CENTER
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 330-C PELHAM ROAD SUITE B-102
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City | GREENVILLE
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State | SC
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Zip | 29615-2961
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Country | US
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Telephone | 864-412-8424
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Fax | 864-412-8012
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Provider Business Mailing Address
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Address Line | 330-C PELHAM ROAD SUITE B-102
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City | GREENVILLE
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State | SC
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Zip | 29615-3534
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Country | US
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Telephone | 864-412-8424
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Fax | 864-412-8012
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Authorized Official
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Title or Position | WOMEN'S HEALTH NURSE PRACTITIONER
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Name | SHANNON MARIE COOKE
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Credential | WHNP-BC
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Telephone | 864-412-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3302
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License Number State | SC
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