Provider Demographics
NPI:1083206312
Name:COOPER, GENECE
Entity Type:Individual
Prefix:
First Name:GENECE
Middle Name:
Last Name:COOPER
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 1:1365 E PARKS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8297
Mailing Address - Country:US
Mailing Address - Phone:907-357-6445
Mailing Address - Fax:
Practice Address - Street 1:6520 W LECKWOLD DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-1606
Practice Address - Country:US
Practice Address - Phone:907-203-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker