Provider Demographics
NPI:1447540075
Name:COOK, MICHELE LATRESE (RN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LATRESE
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3544
Mailing Address - Country:US
Mailing Address - Phone:937-266-0861
Mailing Address - Fax:
Practice Address - Street 1:810 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3544
Practice Address - Country:US
Practice Address - Phone:937-266-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.369135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse