Provider Demographics
NPI:1407441256
Name:COOK, ANANDA (LVN/LPN)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LVN/LPN
Other - Prefix:
Other - First Name:TAI CHI
Other - Middle Name:ANANDA
Other - Last Name:CANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34691 DALEA RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8862
Mailing Address - Country:US
Mailing Address - Phone:951-239-9346
Mailing Address - Fax:
Practice Address - Street 1:641 N VULCAN AVE APT 105
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2193
Practice Address - Country:US
Practice Address - Phone:951-239-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-19961-0164W00000X
CA253696164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse