1669830840 NPI number — MS. CHRISTINA ANN COOK CNP, FNP

Table of content: MS. CHRISTINA ANN COOK CNP, FNP (NPI 1669830840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669830840 NPI number — MS. CHRISTINA ANN COOK CNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
CHRISTINA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNP, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUMMERS
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669830840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SMOKERISE DR. SUITE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WADSWORTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-590-0847
Provider Business Mailing Address Fax Number:
234-201-7644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SMOKERISE DR.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WADSWORTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-590-0847
Provider Business Practice Location Address Fax Number:
234-201-7644
Provider Enumeration Date:
02/03/2016

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: 363LF0000X , with the licence number:  APRN.CNP.18365 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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