Provider Demographics
NPI:1659906469
Name:COOK, DANIELLE ELISA
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELISA
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 1:1370 OLD WATER OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2300
Mailing Address - Country:US
Mailing Address - Phone:443-618-2113
Mailing Address - Fax:
Practice Address - Street 1:1370 OLD WATER OAK POINT RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2300
Practice Address - Country:US
Practice Address - Phone:443-618-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program