Provider Demographics
NPI:1356678494
Name:COOPER, HOLLIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 W HAMPTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4077
Mailing Address - Country:US
Mailing Address - Phone:414-394-2666
Mailing Address - Fax:
Practice Address - Street 1:8200 W BROWN DEER RD STE 210
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1712
Practice Address - Country:US
Practice Address - Phone:414-499-7720
Practice Address - Fax:414-662-5198
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30592731164W00000X
WI22566630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse