Healthcare Provider Details

I. General information

NPI: 1790731735
Provider Name (Legal Business Name): MR. KEVIN WILLIAM ROOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27040 COUNTY ROAD 9
BEMIDJI MN
56601-5456
US

IV. Provider business mailing address

14372 RIVERBEND TRL
THIEF RIVER FALLS MN
56701-8433
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-6405
  • Fax:
Mailing address:
  • Phone: 218-681-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1047318
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR104731-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: