Provider Demographics
NPI:1205198132
Name:COOK, MONIQUE SORAPURU (RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SORAPURU
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:EDGARD
Mailing Address - State:LA
Mailing Address - Zip Code:70049-2515
Mailing Address - Country:US
Mailing Address - Phone:504-458-3978
Mailing Address - Fax:985-497-8685
Practice Address - Street 1:473 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5509
Practice Address - Country:US
Practice Address - Phone:985-536-2128
Practice Address - Fax:985-536-8997
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN043187163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse