Provider Demographics
NPI:1104837574
Name:COOPER, DAVID W (ARNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:COOPER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30809 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4074
Mailing Address - Country:US
Mailing Address - Phone:253-839-2030
Mailing Address - Fax:253-839-1071
Practice Address - Street 1:30809 FIRST AVE. S.
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-839-2030
Practice Address - Fax:253-839-1071
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0235309OtherSTATE L&I
WA0235308OtherSTATE L&I
WA0235310OtherSTATE L&I
WA0232295OtherSTATE L&I
WA0232298OtherSTATE L&I
WA0197067OtherSTATE L&I
WAG8873129Medicare PIN
WA0232295OtherSTATE L&I
WA0197067OtherSTATE L&I
Q47212Medicare UPIN
WAG8871929Medicare PIN