Provider Demographics
NPI:1326686130
Name:COOPER, ANTRANESE LASHAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANTRANESE
Middle Name:LASHAWN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANTRANESE
Other - Middle Name:LASHAWN
Other - Last Name:CADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37930 WESTWOOD CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13929 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3672
Practice Address - Country:US
Practice Address - Phone:313-371-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703115347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty