Provider Demographics
NPI:1174504047
Name:COOK, ELAINE MALVINA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MALVINA
Last Name:COOK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MALVINA
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3813 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1414
Mailing Address - Country:US
Mailing Address - Phone:410-692-9602
Mailing Address - Fax:
Practice Address - Street 1:8615 RIDGELYS CHOICE DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3026
Practice Address - Country:US
Practice Address - Phone:410-766-8009
Practice Address - Fax:410-766-8028
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063214363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health