Provider Demographics
NPI:1104545763
Name:COOK, EMMA THERESE (APRN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:THERESE
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8730
Mailing Address - Country:US
Mailing Address - Phone:402-536-0511
Mailing Address - Fax:
Practice Address - Street 1:1424 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8730
Practice Address - Country:US
Practice Address - Phone:402-536-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-141304-041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse