Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 13888 | TN |
NPI | 1013153857 |
---|---|
Provider Name | Miss Margie Amanda Cook |
First Address | Chattanooga, TN 37421 |
Second Address | Cleveland, TN 37311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2008 |
Last Update Date | 29/04/2020 |