MEDICARE: CINDY COOK-MARTIN 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	50639	NC

General Provider Information

NPI Number	:	1780638825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY COOK-MARTIN CRNA

Provider Business Mailing Address
First Line	:	3417 FAIRWAY LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9453
Country	:	US
Telephone Number	:	919-479-7145
Fax Number	:	919-620-8494

Provider Business Practice Location Address
First Line	:	3417 FAIRWAY LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9453
Country	:	US
Telephone Number	:	919-479-7145
Fax Number	:	919-620-8494

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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