Provider Demographics
NPI:1659131266
Name:COOK, REBECCA L (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 N SQUIRREL RD LOT 117
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4046
Mailing Address - Country:US
Mailing Address - Phone:810-931-3511
Mailing Address - Fax:
Practice Address - Street 1:351 N SQUIRREL RD LOT 117
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4046
Practice Address - Country:US
Practice Address - Phone:810-931-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse