Provider Demographics
NPI:1700457892
Name:COOK, JE'NELLE BROOKE (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:JE'NELLE
Middle Name:BROOKE
Last Name:COOK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 CLARADAY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6502
Mailing Address - Country:US
Mailing Address - Phone:949-202-6433
Mailing Address - Fax:
Practice Address - Street 1:731 CLARADAY ST APT 6
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6502
Practice Address - Country:US
Practice Address - Phone:949-202-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM650176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife