1528468147 NPI number — MISS ANNETTE MICHELLE COOK CNA LEVEL 1 MED AIDE

Table of content: MISS ANNETTE MICHELLE COOK CNA LEVEL 1 MED AIDE (NPI 1528468147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528468147 NPI number — MISS ANNETTE MICHELLE COOK CNA LEVEL 1 MED AIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
ANNETTE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA LEVEL 1 MED AIDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
MICHELL
Provider Other Middle Name:
ANETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528468147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4218 N GRAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63107-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-534-6624
Provider Business Mailing Address Fax Number:
314-535-4394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4218 NORTH GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-534-6624
Provider Business Practice Location Address Fax Number:
314-535-4394
Provider Enumeration Date:
09/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com