Provider Demographics
NPI:1215000286
Name:COOPER, PAULA JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-4870
Mailing Address - Fax:801-475-1621
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:STE 1885
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-4870
Practice Address - Fax:801-475-1621
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAX080126364SC1501X
UT8145615-4405364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP0105486OtherRR PTAN (IHC)
UTP0105486OtherRR PTAN (IHC)