Provider Demographics
NPI:1588099444
Name:COOK, SIERRA LORRAENE
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:LORRAENE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:LORRAENE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9053 TAILOR MADE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0610
Mailing Address - Country:US
Mailing Address - Phone:702-525-5366
Mailing Address - Fax:
Practice Address - Street 1:5138 N JULIANO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4110
Practice Address - Country:US
Practice Address - Phone:702-940-7896
Practice Address - Fax:702-940-8016
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner