Provider Demographics
NPI:1457677106
Name:COOKS, TAMMY K (STNA)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:K
Last Name:COOKS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2621
Mailing Address - Country:US
Mailing Address - Phone:937-277-5657
Mailing Address - Fax:
Practice Address - Street 1:240 FERNWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2621
Practice Address - Country:US
Practice Address - Phone:937-277-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401054600310376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide