Basic Information
| Provider Information | |||||||||
| NPI: | 1639695752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK-MCGIBBON | ||||||||
| FirstName: | DARI | ||||||||
| MiddleName: | NOREEN | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2524 US ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | RAVENA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121432804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187567390 | ||||||||
| FaxNumber: | 5187568030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 11/21/2017 | ||||||||
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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 | 308115 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.