Provider Demographics
NPI:1265891972
Name:DECOOK, RENEE (RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DECOOK
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 1:29667 WINTER CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2685
Mailing Address - Country:US
Mailing Address - Phone:248-943-5160
Mailing Address - Fax:
Practice Address - Street 1:29667 WINTER CT
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2685
Practice Address - Country:US
Practice Address - Phone:248-943-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse