Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 0126002398 | VA |
N | 213ES0000X | Sports Medicine | 0126002398 | VA |
NPI | 1285131524 |
---|---|
Provider Name | Amber Cook |
First Address | Colonial Heights, VA 23834-1942 |
Second Address | Colonial Heights, VA 23834-1942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |