Provider Demographics
NPI:1093472441
Name:COOK, GRETA ROSE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:ROSE
Last Name:COOK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:ROSE
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:19820 VILLAGE OFFICE CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19820 VILLAGE OFFICE CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2947
Practice Address - Country:US
Practice Address - Phone:907-723-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402427RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant