Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 26000 | IA |
NPI | 1083609358 |
---|---|
Provider Name | Jennifer S Cook |
First Address | Des Moines, IA 50309-1453 |
Second Address | Des Moines, IA 50309-1453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083609358 | (05) | IA |
175679 | MEDICARE (01) | |
205746605 | (05) | MO |
D89650 | (02) |