Provider Demographics
NPI:1164679965
Name:COOPER, TAMMY MICHELLE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:M
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:BLDG 6
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-0463
Mailing Address - Fax:
Practice Address - Street 1:1151 TAYLOR ST
Practice Address - Street 2:ROOM 332-C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213329163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse