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General NPI Number Information
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NPI Number | 1700457892
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Entity Type | Individual
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Provider Name | JE'NELLE BROOKE COOK LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 731 CLARADAY ST APT 6
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City | GLENDORA
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State | CA
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Zip | 91740-6502
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Country | US
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Telephone | 949-202-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 731 CLARADAY ST APT 6
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City | GLENDORA
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State | CA
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Zip | 91740-6502
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Country | US
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Telephone | 949-202-6433
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM650
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License Number State | CA
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