Provider Demographics
NPI:1467679928
Name:COOK, MARY JANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:804 SERVICE ROAD
Practice Address - Street 2:ROOM A142
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7039
Practice Address - Country:US
Practice Address - Phone:517-355-3503
Practice Address - Fax:517-432-3742
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704114553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5202009Medicaid
MI0M61830015Medicare PIN
MI5202009Medicaid