| Doctor Name: | MS. LACI NICOLE COOK |
| NPI Number: | 1073906749 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 20142655 |
| Business Practice Address: | 270 Union Ave Holbrook, NY - 117411823 |
| Business Phone Number: | 6315884442 |
| Business Fax Number: | |
| Mailing Address: | 91 Beech St, LAKE GROVE |
| State: | NY |
| Postal Code: | 117553145 |
| Phone Number: | 9177485073 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2015 |
| NPI Last Update Date: | 04/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 20142655 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |