Provider Demographics
NPI:1083324875
Name:COOK, DENISE CUELLAR (NP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:CUELLAR
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:STEFANIE
Other - Last Name:CUELLAR ESPINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10141 DRIFTWOOD ESTATE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8789
Mailing Address - Country:US
Mailing Address - Phone:714-322-0145
Mailing Address - Fax:
Practice Address - Street 1:1090 E DESERT INN RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2803
Practice Address - Country:US
Practice Address - Phone:702-657-3873
Practice Address - Fax:702-636-0787
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250022645Medicaid