Provider Demographics
NPI:1871532077
Name:COOKE, SHEILA KATHLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:KATHLEEN
Last Name:COOKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 DUNLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1644
Mailing Address - Country:US
Mailing Address - Phone:703-978-2737
Mailing Address - Fax:
Practice Address - Street 1:10730 MAIN ST
Practice Address - Street 2:FAIRFAX SURGICAL CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-691-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024092725367500000X
FL3080802367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered