Provider Demographics
NPI:1669739314
Name:COOK, CHRIS J (PDHA II)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:PDHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7809
Mailing Address - Country:US
Mailing Address - Phone:907-463-6678
Mailing Address - Fax:907-463-4032
Practice Address - Street 1:3245 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7809
Practice Address - Country:US
Practice Address - Phone:907-463-6678
Practice Address - Fax:907-463-4032
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK06-035-PDHA IIOtherCOMMUNITY HEALTH AIDE PROGRAM CERTIFICATION BOARD- FEDERAL CERTIFICATION