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General NPI Number Information
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NPI Number | 1619050960
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Entity Type | Individual
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Provider Name | DEBRA SUSAN COOK R.N.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 750 BROADWAY AVE E
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City | MATTOON
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State | IL
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Zip | 61938-4610
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Country | US
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Telephone | 217-238-5700
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Fax | 217-238-5767
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Provider Business Mailing Address
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Address Line | 3115 LOREN LN
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City | CHARLESTON
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State | IL
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Zip | 61920-4417
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Country | US
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Telephone | 217-348-5312
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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 | 41191239
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R20024
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License Number State | NM
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