Healthcare Provider Details

I. General information

NPI: 1285698555
Provider Name (Legal Business Name): JACQUALINE M TERRILL COOKE CNM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SE BAKER ST
MCMINNVILLE OR
97128-6038
US

IV. Provider business mailing address

320 SE BAKER ST
MCMINNVILLE OR
97128-6038
US

V. Phone/Fax

Practice location:
  • Phone: 503-474-3600
  • Fax: 503-474-3601
Mailing address:
  • Phone: 503-474-3600
  • Fax: 503-474-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200040704RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200350072NPFNPPP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200450066NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: