Provider Demographics
NPI:1376270132
Name:COOKS, CHERYL RENEE
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:RENEE
Last Name:COOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:RENEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1099 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4329
Mailing Address - Country:US
Mailing Address - Phone:513-207-8390
Mailing Address - Fax:
Practice Address - Street 1:1099 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4329
Practice Address - Country:US
Practice Address - Phone:513-207-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3125219253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care