Provider Demographics
NPI:1295068708
Name:COOK, SANDRA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 GOLDFIELD PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8208
Mailing Address - Country:US
Mailing Address - Phone:505-508-2686
Mailing Address - Fax:
Practice Address - Street 1:6215 GOLDFIELD PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8208
Practice Address - Country:US
Practice Address - Phone:505-508-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR49396163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency