Provider Demographics
NPI:1558519835
Name:COOK, MAUREEN JOYCE (FNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JOYCE
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:J
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8614
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5622
Practice Address - Country:US
Practice Address - Phone:864-797-7150
Practice Address - Fax:864-797-7155
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1278Medicaid
SCP00715611OtherRR MEDICARE
SCAA34007951Medicare PIN
SCAA34003640Medicare PIN