Provider Demographics
NPI:1639695752
Name:COOK-MCGIBBON, DARI NOREEN (ANP)
Entity Type:Individual
Prefix:
First Name:DARI
Middle Name:NOREEN
Last Name:COOK-MCGIBBON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3900
Mailing Address - Fax:
Practice Address - Street 1:2524 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-2804
Practice Address - Country:US
Practice Address - Phone:518-756-7390
Practice Address - Fax:518-756-8030
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308115363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health