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General NPI Number Information
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NPI Number | 1508261728
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Entity Type | Individual
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Provider Name | JACQUELINE COOKE NP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 01/10/2026
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Provider Practice Location Address
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Address Line | 521 E 86TH AVE STE Z
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6236
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Country | US
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Telephone | 847-920-0902
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Fax | 219-209-5774
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Provider Business Mailing Address
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Address Line | 8732 S 800 W
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City | WANATAH
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State | IN
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Zip | 46390-9532
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Country | US
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Telephone | 219-309-5780
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Fax | 219-209-5774
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71005252A
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License Number State | IN
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