Provider Demographics
NPI:1932522752
Name:COOK, AMBER JOY (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JOY
Last Name:COOK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:JOY
Other - Last Name:HOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5246 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-939-3000
Mailing Address - Fax:208-939-3030
Practice Address - Street 1:5246 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-939-3000
Practice Address - Fax:208-939-3030
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist