Provider Demographics
NPI:1316173321
Name:COOK, /TIWANNA TINA (LPN)
Entity type:Individual
Prefix:
First Name:/TIWANNA
Middle Name:TINA
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 N LINCOLNSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6341
Mailing Address - Country:US
Mailing Address - Phone:414-760-9122
Mailing Address - Fax:
Practice Address - Street 1:6918 N LINCOLNSHIRE CIR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6341
Practice Address - Country:US
Practice Address - Phone:414-760-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304277164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38317400OtherPROVIDER