Provider Demographics
NPI:1548871650
Name:COOK, CLEVA
Entity type:Individual
Prefix:
First Name:CLEVA
Middle Name:
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 66
Mailing Address - Street 2:
Mailing Address - City:DILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26617-0066
Mailing Address - Country:US
Mailing Address - Phone:304-619-8843
Mailing Address - Fax:
Practice Address - Street 1:6827 WIDEN DILLE RD
Practice Address - Street 2:
Practice Address - City:DILLE
Practice Address - State:WV
Practice Address - Zip Code:26617-9537
Practice Address - Country:US
Practice Address - Phone:304-619-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant