MEDICARE: MARIA COOK RN

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	RN.335131	OH

General Provider Information

NPI Number	:	1942627492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA COOK RN

Provider Business Mailing Address
First Line	:	4005 DEER PARK AVE
Second Line	:	APT1
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3407
Country	:	US
Telephone Number	:	513-532-9825
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 DEER PARK AVE
Second Line	:	APT1
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3407
Country	:	US
Telephone Number	:	513-532-9825
Fax Number	:

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

Provider Enumeration Date	:	03/22/2014
Last Update Date	:	03/22/2014

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