Provider Demographics
NPI:1538315734
Name:COOPER, CINDY L (RN, AE-C)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, AE-C
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:BROWN/BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19215 SE 34TH ST STE 106
Mailing Address - Street 2:PMB 379
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8830
Mailing Address - Country:US
Mailing Address - Phone:360-567-3984
Mailing Address - Fax:360-567-3985
Practice Address - Street 1:821 NW FREMONT ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9376
Practice Address - Country:US
Practice Address - Phone:360-567-3984
Practice Address - Fax:360-567-3985
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00077876163W00000X
OR200840657RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse