Provider Demographics
NPI:1871572412
Name:COOK, CATHY J (DNP, APRN,CNM)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:DNP, APRN,CNM
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:J
Other - Last Name:BAUMGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 130TH ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-9122
Mailing Address - Country:US
Mailing Address - Phone:309-299-8687
Mailing Address - Fax:
Practice Address - Street 1:2118 130TH ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-9122
Practice Address - Country:US
Practice Address - Phone:309-299-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002163367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03450OtherWELLMARK
IAS-48312Medicare UPIN
IA03450OtherWELLMARK