Provider Demographics
NPI:1124365705
Name:COOPER, VIRGINIA LEE (RN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:COOPER
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 1:6649 75TH ST NW
Mailing Address - Street 2:APT B
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-2180
Mailing Address - Country:US
Mailing Address - Phone:608-769-5591
Mailing Address - Fax:
Practice Address - Street 1:6649 75TH ST NW
Practice Address - Street 2:APT B
Practice Address - City:ORONOCO
Practice Address - State:MN
Practice Address - Zip Code:55960-2180
Practice Address - Country:US
Practice Address - Phone:608-769-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR167746-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse