Provider Demographics
NPI:1194690826
Name:COOKS, VRUNDER LATINA (RMA)
Entity type:Individual
Prefix:
First Name:VRUNDER
Middle Name:LATINA
Last Name:COOKS
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 CARBON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1730
Mailing Address - Country:US
Mailing Address - Phone:419-559-4715
Mailing Address - Fax:
Practice Address - Street 1:1312 CARBON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1730
Practice Address - Country:US
Practice Address - Phone:419-559-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2899452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty