Provider Demographics
NPI:1124359823
Name:COOK, TANDA LEIGH (ND)
Entity Type:Individual
Prefix:DR
First Name:TANDA
Middle Name:LEIGH
Last Name:COOK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 S FERGUSON AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6493
Mailing Address - Country:US
Mailing Address - Phone:406-551-1441
Mailing Address - Fax:406-551-1442
Practice Address - Street 1:670 S FERGUSON AVE
Practice Address - Street 2:STE 3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6493
Practice Address - Country:US
Practice Address - Phone:406-551-1441
Practice Address - Fax:406-551-1442
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT123175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath