Provider Demographics
NPI:1447958863
Name:COOK, SHANNON NICOLE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:COOK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 W 100 S
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46147-8829
Mailing Address - Country:US
Mailing Address - Phone:765-894-6033
Mailing Address - Fax:
Practice Address - Street 1:8237 W 100 S
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46147-8829
Practice Address - Country:US
Practice Address - Phone:765-894-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered