Provider Demographics
NPI:1124011986
Name:COOPER, GLORIA R (CRNA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 STONY POINT PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1962
Mailing Address - Country:US
Mailing Address - Phone:804-775-4500
Mailing Address - Fax:804-545-1632
Practice Address - Street 1:8700 STONY POINT PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1962
Practice Address - Country:US
Practice Address - Phone:804-775-4500
Practice Address - Fax:804-545-1632
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001030728163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8951675Medicaid
VA00W155S06Medicare ID - Type Unspecified
VA8951675Medicaid