Provider Demographics
NPI:1780638825
Name:COOK-MARTIN, CINDY (CRNA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:COOK-MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-9453
Mailing Address - Country:US
Mailing Address - Phone:919-479-7145
Mailing Address - Fax:919-620-8494
Practice Address - Street 1:3417 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-9453
Practice Address - Country:US
Practice Address - Phone:919-479-7145
Practice Address - Fax:919-620-8494
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50639367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2612555BMedicare ID - Type Unspecified