Provider Demographics
NPI:1023557485
Name:COOKE'S CONTINENCE CENTER
Entity Type:Organization
Organization Name:COOKE'S CONTINENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOMEN'S HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-BC
Authorized Official - Phone:864-412-8424
Mailing Address - Street 1:330-C PELHAM ROAD
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3534
Mailing Address - Country:US
Mailing Address - Phone:864-412-8424
Mailing Address - Fax:864-412-8012
Practice Address - Street 1:330-C PELHAM ROAD
Practice Address - Street 2:SUITE B-102
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2961
Practice Address - Country:US
Practice Address - Phone:864-412-8424
Practice Address - Fax:864-412-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3302261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3302OtherSC STATE LICENSE
SC1619168473OtherINDIVIDUAL NPI