Provider Demographics
NPI:1083096978
Name:COOK, MARSHELLDRA NACOLE
Entity type:Individual
Prefix:
First Name:MARSHELLDRA
Middle Name:NACOLE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0189
Mailing Address - Country:US
Mailing Address - Phone:580-319-7305
Mailing Address - Fax:
Practice Address - Street 1:2425 W UNIVERSITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2970
Practice Address - Country:US
Practice Address - Phone:809-247-3305
Practice Address - Fax:580-924-7334
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist