Provider Demographics
NPI:1437693207
Name:COOKE, AMY (RN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:COOKE
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 1:103 CANADA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9806
Mailing Address - Country:US
Mailing Address - Phone:716-537-8264
Mailing Address - Fax:716-537-8252
Practice Address - Street 1:103 CANADA ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9806
Practice Address - Country:US
Practice Address - Phone:716-537-8264
Practice Address - Fax:716-537-8252
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 562885163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22 562885OtherRN