Provider Demographics
NPI:1164610648
Name:COOK, CHRISTINE MAY (PHN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MAY
Last Name:COOK
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2245
Mailing Address - Country:US
Mailing Address - Phone:805-473-7135
Mailing Address - Fax:805-474-7473
Practice Address - Street 1:286 S 16TH ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2245
Practice Address - Country:US
Practice Address - Phone:805-473-7135
Practice Address - Fax:805-474-7473
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN301652163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn