Doctor Name: | BREANNA MARIE COOK |
NPI Number: | 1144628835 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | |
Business Practice Address: | 56649 Forest Blvd Pine City, MN - 550639067 |
Business Phone Number: | 7632209157 |
Business Fax Number: | |
Mailing Address: | 56649 Forest Blvd, PINE CITY |
State: | MN |
Postal Code: | 550639067 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/11/2014 |
NPI Last Update Date: | 12/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |