Healthcare Provider Details

I. General information

NPI: 1992481543
Provider Name (Legal Business Name): CORINN RENEE COOK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S C ST
MILFORD NE
68405-1802
US

IV. Provider business mailing address

300 N COLUMBIA AVE
SEWARD NE
68434-2299
US

V. Phone/Fax

Practice location:
  • Phone: 402-761-3307
  • Fax: 402-761-3493
Mailing address:
  • Phone: 402-643-4800
  • Fax: 402-646-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3220
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: