Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 6009038 | NY |
NPI | 1003588732 |
---|---|
Provider Name | Davita J Cook |
First Address | Huber Heights, OH 45424-5921 |
Second Address | Huber Heights, OH 45424-5921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2021 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0287258 | (05) | OH |