Provider Demographics
NPI:1477274736
Name:COOPER, VRON MIKELL (RN)
Entity Type:Individual
Prefix:
First Name:VRON
Middle Name:MIKELL
Last Name:COOPER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 DESERT WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1188
Mailing Address - Country:US
Mailing Address - Phone:405-203-3924
Mailing Address - Fax:
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4835
Practice Address - Country:US
Practice Address - Phone:530-587-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95082900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0735170788OtherPROFESSIONAL LIABILITY POLICY