Provider Demographics
NPI:1033877576
Name:COOPER HOLGUIN, MICHELLE LIN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LIN
Last Name:COOPER HOLGUIN
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 1:940 BILLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6218
Mailing Address - Country:US
Mailing Address - Phone:505-215-5625
Mailing Address - Fax:
Practice Address - Street 1:3401 E 30TH ST STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8805
Practice Address - Country:US
Practice Address - Phone:505-324-9840
Practice Address - Fax:855-290-2205
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM406438163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool