Provider Demographics
NPI:1609557339
Name:COOPER, MARICELA ANN
Entity Type:Individual
Prefix:
First Name:MARICELA
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 COACHMAN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-4812
Mailing Address - Country:US
Mailing Address - Phone:541-621-0595
Mailing Address - Fax:
Practice Address - Street 1:1011 COACHMAN DR
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-4812
Practice Address - Country:US
Practice Address - Phone:541-621-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide