Provider Demographics
NPI:1114635638
Name:COOK, OLIVIA L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MACIEJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:1509 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2742
Practice Address - Country:US
Practice Address - Phone:410-757-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine