| Doctor Name: | CANDACE K COOK |
| NPI Number: | 1043277197 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 209.004563 |
| Business Practice Address: | Coulterville Medical Clinic 203 East Grant Coulterville, IL - 62237 |
| Business Phone Number: | 6187582331 |
| Business Fax Number: | |
| Mailing Address: | Coulterville Medical Clinic, 203 East Grant COULTERVILLE |
| State: | IL |
| Postal Code: | 62237 |
| Phone Number: | 6187582331 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2006 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.004563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |