Basic Information
| Provider Information | |||||||||
| NPI: | 1538165683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302538195 | ||||||||
| FaxNumber: | 3302530853 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302538195 | ||||||||
| FaxNumber: | 3302530853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 125898 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 2315364 | 05 | OH | MEDICAID |