Individual
DEBRA SUE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
209 E JEFFERSON ST, PLYMOUTH, IN 46563-1861
(574) 941-3111
(574) 335-0745
Mailing address
707 E CEDAR ST, STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000505
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000322873
BCBS
IN
05
—
200190130A
—
IN
Enumeration date
04/04/2007
Last updated
02/07/2020
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