Provider Demographics
NPI:1730777327
Name:COOK, DAWN MARIE (LPN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAWN MARIE COOK LPN
Mailing Address - Street 1:361 W GALBRAITH LINE RD
Mailing Address - Street 2:
Mailing Address - City:MELVIN
Mailing Address - State:MI
Mailing Address - Zip Code:48454-9733
Mailing Address - Country:US
Mailing Address - Phone:248-214-7812
Mailing Address - Fax:
Practice Address - Street 1:361 W GALBRAITH LINE RD
Practice Address - Street 2:
Practice Address - City:MELVIN
Practice Address - State:MI
Practice Address - Zip Code:48454-9733
Practice Address - Country:US
Practice Address - Phone:248-214-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703103342164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse