MEDICARE: ERIN L COOKE CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN85024	NV
2	363LW0102X	Women's Health Nurse Practitioner	APRN002027	NV

General Provider Information

NPI Number	:	1255768891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN L COOKE CNP

Provider Business Mailing Address
First Line	:	280 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2936
Country	:	US
Telephone Number	:	702-759-1039
Fax Number	:	702-759-1432

Provider Business Practice Location Address
First Line	:	280 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2936
Country	:	US
Telephone Number	:	702-759-1039
Fax Number	:	702-759-1432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	06/04/2019

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