Provider Demographics
NPI:1598762999
Name:COOPER, DAVID (RNFA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2967
Mailing Address - Country:US
Mailing Address - Phone:618-233-5722
Mailing Address - Fax:618-233-7069
Practice Address - Street 1:9 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2967
Practice Address - Country:US
Practice Address - Phone:618-233-5722
Practice Address - Fax:618-233-7069
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041237530163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041237530OtherLICENSE
MO108646OtherLICENSE