Individual
MRS. MARY K. COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
13992 MANCHESTER RD, MANCHESTER, MO 63011-4517
(866) 825-3227
Mailing address
1701 N. 12TH ST, QUINCY, IL 62301-1355
(217) 222-8641
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
045711
MO
363LF0000X
Family Nurse Practitioner
209001740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00104970
RAIL ROAD MEDICARE
—
Enumeration date
07/04/2006
Last updated
05/14/2018
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