Individual
KATHLEEN COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-0924
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704111690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104314270
—
MI
01
—
KC111690
BLUE CROSS OF MI
MI
Enumeration date
06/30/2006
Last updated
08/04/2015
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