Provider Demographics
NPI:1609921014
Name:DECOOK, NANCY J (FNPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:DECOOK
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17950 PRESTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5792
Mailing Address - Country:US
Mailing Address - Phone:972-354-5720
Mailing Address - Fax:972-354-5747
Practice Address - Street 1:1325 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-663-6511
Practice Address - Fax:970-663-6513
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29870861Medicaid
CO29870861Medicaid
CO29870861Medicare PIN
CO807828Medicare PIN
CO29870861Medicare Oscar/Certification