Provider Demographics
NPI:1760421879
Name:COOK, REBECCA SUE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:COOK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3764 MASON MORROW MILLGROVE RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-9612
Mailing Address - Country:US
Mailing Address - Phone:513-899-9302
Mailing Address - Fax:513-636-7826
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 3019
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7157
Practice Address - Fax:513-636-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-196408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338689Medicaid