Provider Demographics
NPI:1609800036
Name:COOPER, ELIZABETH M (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-0638
Mailing Address - Fax:585-273-3359
Practice Address - Street 1:905 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7141
Practice Address - Country:US
Practice Address - Phone:585-275-7892
Practice Address - Fax:585-341-6673
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000151367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD403ROtherPREFERRED CARE
NY7348242OtherAETNA
NYP010234889OtherBLUE CHOICE
NY00801309Medicaid
NYP010234889OtherBLUE CHOICE
NYR54888Medicare UPIN