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General NPI Number Information
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NPI Number | 1396397089
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Entity Type | Individual
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Provider Name | LAURA COOK ACCNS-AG
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-294-6289
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Fax |
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Provider Business Mailing Address
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Address Line | 587 HENLEY ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5682
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Country | US
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Telephone | 248-818-0774
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 4704263716
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License Number State | MI
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