Provider Demographics
NPI:1568780815
Name:COOK, ADELE SOJOURNER (LPN)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:SOJOURNER
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PECK SLIP STATION PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10272
Mailing Address - Country:US
Mailing Address - Phone:732-791-8155
Mailing Address - Fax:
Practice Address - Street 1:169 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2817
Practice Address - Country:US
Practice Address - Phone:732-791-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235931164W00000X
PAPN152360L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse