Individual
ANDREA COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2295 FOOTHILL DR, SALT LAKE CITY, UT 84109-4000
(801) 486-3021
(801) 485-6339
Mailing address
2295 FOOTHILL DR, SALT LAKE CITY, UT 84109-4000
(801) 486-3021
(801) 485-6339
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
77808351206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77808351206
PHYSICIAN ASSISTANT LICENSE
UT
Enumeration date
09/30/2010
Last updated
09/30/2010
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