=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760421879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA SUE COOK CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2006
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 BURNET AVE ML 3019
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45229-3026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-636-7157
-----------------------------------------------------
Fax | 513-636-7826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3764 MASON MORROW MILLGROVE RD
-----------------------------------------------------
City | MORROW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45152-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-899-9302
-----------------------------------------------------
Fax | 513-636-7826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | RN-196408
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------