Provider Demographics
NPI:1629749387
Name:COOK, MOLLY ALEESE (RN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ALEESE
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11384 COPPERLEAF LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2803
Mailing Address - Country:US
Mailing Address - Phone:858-382-1262
Mailing Address - Fax:
Practice Address - Street 1:11384 COPPERLEAF LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2803
Practice Address - Country:US
Practice Address - Phone:858-382-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67786163WC1500X
CA620534163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health