MEDICARE: ERIN MARIE COOK HIS

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	237700000X	Hearing Instrument Specialist	2718	MN

General Provider Information

NPI Number	:	1235493966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARIE COOK HIS

Provider Business Mailing Address
First Line	:	5000 CHESHIRE PKWY N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-4103
Country	:	US
Telephone Number	:	888-510-0766
Fax Number	:	763-268-4017

Provider Business Practice Location Address
First Line	:	4723 HIAWATHA AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3928
Country	:	US
Telephone Number	:	612-272-6338
Fax Number	:	612-729-8378

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

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	06/04/2013

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