MEDICARE: TODD COOK

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	CRNA1458	AZ

General Provider Information

NPI Number	:	1942662374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD COOK

Provider Business Mailing Address
First Line	:	7416 E LOBO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-4940
Country	:	US
Telephone Number	:	208-569-3616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3828 E OMEGA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-9792
Country	:	US
Telephone Number	:	208-569-3616
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	04/10/2018

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Directions to “ TODD COOK ” Practice Location

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