Provider Demographics
NPI:1366514515
Name:COOK, AMY ELISABETH (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELISABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:570-465-7488
Mailing Address - Fax:
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-770-1155
Practice Address - Fax:607-770-1968
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB0366Medicare PIN
Q19471Medicare UPIN