Provider Demographics
NPI:1093952491
Name:COOKS, IVY MITCHELL (BS, NA)
Entity Type:Individual
Prefix:MISS
First Name:IVY
Middle Name:MITCHELL
Last Name:COOKS
Suffix:
Gender:F
Credentials:BS, NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOULDER SPRINGS DR
Mailing Address - Street 2:#B2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5535
Mailing Address - Country:US
Mailing Address - Phone:804-617-1762
Mailing Address - Fax:804-447-1449
Practice Address - Street 1:800 BOULDER SPRINGS DR
Practice Address - Street 2:#B2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5535
Practice Address - Country:US
Practice Address - Phone:804-617-1762
Practice Address - Fax:804-447-1449
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide