Provider Demographics
NPI:1003142639
Name:MARY ELAINE COOK
Entity Type:Organization
Organization Name:MARY ELAINE COOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECURTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-345-6668
Mailing Address - Street 1:2145 SANTA CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3321
Mailing Address - Country:US
Mailing Address - Phone:520-458-1736
Mailing Address - Fax:
Practice Address - Street 1:2145 SANTA CATALINA DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3321
Practice Address - Country:US
Practice Address - Phone:520-458-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN138025251J00000X
FLRN9218626251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care