Provider Demographics
NPI:1346543071
Name:COOPER, SEPTEMBER ROYELLE (LPN)
Entity Type:Individual
Prefix:
First Name:SEPTEMBER
Middle Name:ROYELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 LANGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3514
Mailing Address - Country:US
Mailing Address - Phone:516-536-9429
Mailing Address - Fax:
Practice Address - Street 1:1349 LANGDON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3514
Practice Address - Country:US
Practice Address - Phone:516-536-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse