Provider Demographics
NPI:1003409244
Name:COOK, TONYA ALAE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:ALAE
Last Name:COOK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 FAIRDEL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2443
Mailing Address - Country:US
Mailing Address - Phone:443-854-3082
Mailing Address - Fax:
Practice Address - Street 1:6200 FAIRDEL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2443
Practice Address - Country:US
Practice Address - Phone:443-854-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse