Provider Demographics
NPI:1275245839
Name:COOPER, EVANA SHARRON
Entity Type:Individual
Prefix:
First Name:EVANA
Middle Name:SHARRON
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WILLOW TURN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3162
Mailing Address - Country:US
Mailing Address - Phone:856-520-1239
Mailing Address - Fax:
Practice Address - Street 1:350 WILLOW TURN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3162
Practice Address - Country:US
Practice Address - Phone:856-520-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula