Provider Demographics
NPI:1588216782
Name:COOK, LAURA CATHERINE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHERINE
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 1:1 BROOKLINE PL STE 406
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7296
Mailing Address - Country:US
Mailing Address - Phone:617-278-8000
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKLINE PL STE 406
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7296
Practice Address - Country:US
Practice Address - Phone:617-278-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2293245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily