MEDICARE: JANET MICHELLE COOK LPB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	201909414LPN	OR

General Provider Information

NPI Number	:	1164106258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MICHELLE COOK LPB

Provider Business Mailing Address
First Line	:	36 SW NYE ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-3821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SW COAST HWY STE 102
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4988
Country	:	US
Telephone Number	:	154-126-5494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	06/09/2023

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Directions to “ JANET MICHELLE COOK LPB” Practice Location

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