Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 207228 | GA |
NPI | 1134675531 |
---|---|
Provider Name | Shaun Cook |
First Address | Albany, GA 31701-1943 |
Second Address | Albany, GA 31701-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 26/08/2016 |