Provider Demographics
NPI:1245330505
Name:ROOK, CARRIE MARIE (IDC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:ROOK
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 LEDURA RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7252
Mailing Address - Country:US
Mailing Address - Phone:757-493-3561
Mailing Address - Fax:
Practice Address - Street 1:1915 C AVE
Practice Address - Street 2:CEP-171 ROOM 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3705
Practice Address - Country:US
Practice Address - Phone:757-445-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman