Provider Demographics
NPI:1639461833
Name:COOK, CATHERINE JOHNSON (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JOHNSON
Last Name:COOK
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2122 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2849
Mailing Address - Country:US
Mailing Address - Phone:970-722-2400
Mailing Address - Fax:520-323-7531
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:970-722-2400
Practice Address - Fax:520-323-7531
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057211163W00000X
AZAP4012363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ686790Medicaid
AZ686790Medicaid