Provider Demographics
NPI:1871064808
Name:COOK, SHANNA E (PHLEBOTOMIST SPECIAL)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:PHLEBOTOMIST SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20843 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2217
Mailing Address - Country:US
Mailing Address - Phone:248-506-7849
Mailing Address - Fax:
Practice Address - Street 1:20843 GARDEN LN
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2217
Practice Address - Country:US
Practice Address - Phone:248-506-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X, 246QL0900X, 343900000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No174400000XOther Service ProvidersSpecialist
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)