Healthcare Provider Details

I. General information

NPI: 1346699972
Provider Name (Legal Business Name): COURTNEY COOK MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE 407
ROYAL OAK MI
48073
US

IV. Provider business mailing address

20952 E 12 MILE RD SUITE 200
SAINT CLAIR SHORES MI
48081-3200
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0638
  • Fax: 248-551-4491
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704275634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: