Healthcare Provider Details

I. General information

NPI: 1023975588
Provider Name (Legal Business Name): JORDAN MARIE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17187 SCHAEFER HWY
DETROIT MI
48235-4132
US

IV. Provider business mailing address

17187 SCHAEFER HWY
DETROIT MI
48235-4132
US

V. Phone/Fax

Practice location:
  • Phone: 248-444-2982
  • Fax: 313-367-2818
Mailing address:
  • Phone:
  • Fax: 313-367-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704404063
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: