Provider Demographics
NPI:1710259320
Name:COOPER, PATRICIA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CROSSROADS BLVD.
Mailing Address - Street 2:#152
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8674
Mailing Address - Country:US
Mailing Address - Phone:248-310-5929
Mailing Address - Fax:
Practice Address - Street 1:225 CROSSROADS BLVD
Practice Address - Street 2:#152
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8674
Practice Address - Country:US
Practice Address - Phone:248-310-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702567163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health