Healthcare Provider Details

I. General information

NPI: 1730402108
Provider Name (Legal Business Name): JULIE ANN COOK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E MAIN STREET
OGEMA MN
56569
US

IV. Provider business mailing address

407 E MAIN STREET
OGEMA MN
56569
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-3900
  • Fax: 218-983-3902
Mailing address:
  • Phone: 218-983-3900
  • Fax: 218-983-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 1859700
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: