Provider Demographics
NPI:1295232510
Name:COOK, JACQUELYN MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:MARIE
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:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-1209
Mailing Address - Country:US
Mailing Address - Phone:720-475-6626
Mailing Address - Fax:
Practice Address - Street 1:8354 E NORTHFIELD BLVD STE 3700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3131
Practice Address - Country:US
Practice Address - Phone:720-465-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1626122163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health