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General NPI Number Information
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NPI Number | 1134492721
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Entity Type | Individual
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Provider Name | NICOLE P CORK BSW
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Gender | Female
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1407 SAINT ANDREW ST STE 100
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City | LA CROSSE
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State | WI
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Zip | 54603-2378
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Country | US
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Telephone | 608-785-3611
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Fax |
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Provider Business Mailing Address
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Address Line | W12923 5TH ST
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City | OSSEO
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State | WI
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Zip | 54758-7496
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Country | US
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Telephone | 715-533-1164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 8419-120
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License Number State | WI
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