Provider Demographics
NPI:1346002136
Name:COOKE, MELISSA MARIE
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:COOKE
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 1:153 WANDA RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9049
Mailing Address - Country:US
Mailing Address - Phone:740-357-8604
Mailing Address - Fax:
Practice Address - Street 1:153 WANDA RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-9049
Practice Address - Country:US
Practice Address - Phone:740-357-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide