Healthcare Provider Details

I. General information

NPI: 1063320380
Provider Name (Legal Business Name): DANIEL COOK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 E HOOVER AVE
FALL CREEK WI
54742-9609
US

IV. Provider business mailing address

336 E HOOVER AVE
FALL CREEK WI
54742-9609
US

V. Phone/Fax

Practice location:
  • Phone: 715-877-1504
  • Fax:
Mailing address:
  • Phone: 715-877-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number246674-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: