1700044096 NPI number — MRS. SHONAREESA RHOLENCIA MEDLEY COOK CRT

Table of content: MRS. SHONAREESA RHOLENCIA MEDLEY COOK CRT (NPI 1700044096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700044096 NPI number — MRS. SHONAREESA RHOLENCIA MEDLEY COOK CRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDLEY COOK
Provider First Name:
SHONAREESA
Provider Middle Name:
RHOLENCIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDLEY
Provider Other First Name:
SHONAREESA
Provider Other Middle Name:
RHOLENCIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700044096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7446 SENECA RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-9479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-428-3298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7446 SENECA RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-9479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-428-3298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2008

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: 227800000X , with the licence number:  L0004521 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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