Provider Demographics
NPI:1275300691
Name:COOK, JANE LIANNE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LIANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HALF MOON BAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68527-1525
Mailing Address - Country:US
Mailing Address - Phone:308-991-8240
Mailing Address - Fax:
Practice Address - Street 1:6900 VAN DORN ST STE 12
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2882
Practice Address - Country:US
Practice Address - Phone:402-814-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist