MEDICARE: MR. ROBIN EDWARD COOK CRNA

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	367500000X	Certified Registered Nurse Anesthetist	67576	OK

General Provider Information

NPI Number	:	1619288693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBIN EDWARD COOK CRNA

Provider Business Mailing Address
First Line	:	1209 N HARVEY AVE APT 303
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3729
Country	:	US
Telephone Number	:	405-209-8058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 N HARVEY AVE APT 303
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3729
Country	:	US
Telephone Number	:	405-209-8058
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/26/2013

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