Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036128205 | IL |
NPI | 1356487904 |
---|---|
Provider Name | Marisha L. Cook |
First Address | Rockford, IL 61103-3619 |
Second Address | Rockford, IL 61103-3619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 09/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
616040130 | (02) | IL |