Provider Demographics
NPI:1063095107
Name:COOK, NIKI ANN
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 S 17TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6649
Mailing Address - Country:US
Mailing Address - Phone:218-686-5578
Mailing Address - Fax:
Practice Address - Street 1:3015 S 17TH ST APT 102
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6649
Practice Address - Country:US
Practice Address - Phone:218-686-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No174200000XOther Service ProvidersMeals
No172A00000XOther Service ProvidersDriver
No251E00000XAgenciesHome HealthGroup - Single Specialty