Provider Demographics
NPI:1194451302
Name:COOK, NATASHA DIAMOND RIO
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:DIAMOND RIO
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 1:1 WASHINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3965
Mailing Address - Country:US
Mailing Address - Phone:304-824-3100
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3965
Practice Address - Country:US
Practice Address - Phone:304-824-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist