Provider Demographics
NPI:1558527200
Name:JONES COOPER, PATRICIA M (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:JONES COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N. MAYFAIR RD.
Mailing Address - Street 2:STE. 500
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-257-2525
Mailing Address - Fax:414-257-1772
Practice Address - Street 1:525 W. RIVER WOODS PKWY.
Practice Address - Street 2:STE. 130
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-961-0304
Practice Address - Fax:414-961-2061
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3508-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP01650009OtherRAILROAD MEDICARE
WI1558527200Medicaid
WIK400117987Medicare PIN