Provider Demographics
NPI:1578986238
Name:COOK, LADAWN
Entity Type:Individual
Prefix:
First Name:LADAWN
Middle Name:
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 1:4855 VEGAS VALLEY DR
Mailing Address - Street 2:APT 255
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2000
Mailing Address - Country:US
Mailing Address - Phone:313-409-4603
Mailing Address - Fax:
Practice Address - Street 1:4855 VEGAS VALLEY DR
Practice Address - Street 2:APT 255
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2000
Practice Address - Country:US
Practice Address - Phone:313-409-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor