Provider Demographics
NPI:1467782243
Name:COOK, SANDRA SOSLAU (CRNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SOSLAU
Last Name:COOK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:HELEN
Other - Last Name:SOSLUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1332 CAPE ST CLAIRE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5216
Practice Address - Country:US
Practice Address - Phone:443-951-4280
Practice Address - Fax:443-949-0641
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR251828363L00000X
PASP010646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP010646OtherCRNP LICENSE