Basic Information
| Provider Information | |||||||||
| NPI: | 1255547691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23500 US HIGHWAY 160 | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810899524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197385100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23450 US HIGHWAY 160 | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810898100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197384588 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | DR.0050479 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.