Provider Demographics
NPI:1255453510
Name:COOK, BRONWYN L
Entity type:Individual
Prefix:MISS
First Name:BRONWYN
Middle Name:L
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 1:2573 STONEY WAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1152
Mailing Address - Country:US
Mailing Address - Phone:614-801-2551
Mailing Address - Fax:
Practice Address - Street 1:2573 STONEY WAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1152
Practice Address - Country:US
Practice Address - Phone:614-801-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2310127Medicaid