Provider Demographics
NPI:1134245269
Name:COOK, MARGE L (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARGE
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4067
Mailing Address - Country:US
Mailing Address - Phone:616-647-2802
Mailing Address - Fax:616-647-2805
Practice Address - Street 1:4467 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9723
Practice Address - Country:US
Practice Address - Phone:616-877-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703012314164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse