Provider Demographics
NPI:1467050864
Name:COOK, DOMONIQUE J
Entity Type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-9492
Mailing Address - Country:US
Mailing Address - Phone:304-860-9527
Mailing Address - Fax:
Practice Address - Street 1:203 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-9492
Practice Address - Country:US
Practice Address - Phone:304-860-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant