MEDICARE: ELIZABETH M COOK FNP

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	363LF0000X	Family Nurse Practitioner	200250029NP	OR
2	363LF0000X	Family Nurse Practitioner	AP30007055	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629049705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M COOK FNP

Provider Business Mailing Address
First Line	:	700 NE 87TH AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1913
Country	:	US
Telephone Number	:	360-397-3352
Fax Number	:	360-604-1771

Provider Business Practice Location Address
First Line	:	291 C ST UNIT 110
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2168
Country	:	US
Telephone Number	:	360-882-2778
Fax Number	:	360-604-1644

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	05/11/2018

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