Provider Demographics
NPI:1780240515
Name:ROOK, CAROL JANE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JANE
Last Name:ROOK
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 1:12920 HILLSIDE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3260
Mailing Address - Country:US
Mailing Address - Phone:336-688-4242
Mailing Address - Fax:
Practice Address - Street 1:225 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2626
Practice Address - Country:US
Practice Address - Phone:907-729-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR29539163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNURR29539OtherRN
AKNURR29539Medicaid