Healthcare Provider Details

I. General information

NPI: 1841714979
Provider Name (Legal Business Name): JANI LEE COOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANI LEE MORGAN NP

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 COMMANCHE AVE
GREEN BAY WI
54313-5751
US

IV. Provider business mailing address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

V. Phone/Fax

Practice location:
  • Phone: 920-435-8326
  • Fax: 920-430-4659
Mailing address:
  • Phone: 920-445-7226
  • Fax: 920-445-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7827-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: