Provider Demographics
NPI:1356347116
Name:COOK, BRUCE W (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:W
Last Name:COOK
Suffix:
Gender:M
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-0250
Mailing Address - Country:US
Mailing Address - Phone:785-877-3351
Mailing Address - Fax:785-877-2841
Practice Address - Street 1:102 E HOLME ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-1406
Practice Address - Country:US
Practice Address - Phone:785-877-3351
Practice Address - Fax:785-877-2841
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54992367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
145044Medicare UPIN