Provider Demographics
NPI:1952959561
Name:COOK, PATRICIA R
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:COOK
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 1:474 MAHONEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920
Mailing Address - Country:US
Mailing Address - Phone:518-497-6824
Mailing Address - Fax:
Practice Address - Street 1:474 MAHONEY ROAD
Practice Address - Street 2:
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920
Practice Address - Country:US
Practice Address - Phone:518-497-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider