Provider Demographics
NPI:1457091423
Name:COOK, CATHERINE MARIE (MSN, APRN, AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:MSN, APRN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19316 W HARBOUR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-3151
Mailing Address - Country:US
Mailing Address - Phone:734-358-9196
Mailing Address - Fax:
Practice Address - Street 1:19316 W HARBOUR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-3151
Practice Address - Country:US
Practice Address - Phone:734-358-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306864364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist