Provider Demographics
NPI:1972251742
Name:COOKE, CATHY (BCHN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:COOKE
Suffix:
Gender:F
Credentials:BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3809
Mailing Address - Country:US
Mailing Address - Phone:208-391-7611
Mailing Address - Fax:
Practice Address - Street 1:688 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3809
Practice Address - Country:US
Practice Address - Phone:970-485-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist