Provider Demographics
NPI:1669119475
Name:COOKS, DAVIAN
Entity type:Individual
Prefix:
First Name:DAVIAN
Middle Name:
Last Name:COOKS
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 1:2809 VIENNA VIEW CT SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-5629
Mailing Address - Country:US
Mailing Address - Phone:330-313-6655
Mailing Address - Fax:
Practice Address - Street 1:2809 VIENNA VIEW CT SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-5629
Practice Address - Country:US
Practice Address - Phone:330-313-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty