Provider Demographics
NPI:1730640129
Name:COOPER, LAREE LEE
Entity Type:Individual
Prefix:MS
First Name:LAREE
Middle Name:LEE
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 1:7743 SEWARD PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4248
Mailing Address - Country:US
Mailing Address - Phone:206-497-0470
Mailing Address - Fax:206-497-0469
Practice Address - Street 1:7743 SEWARD PARK AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4248
Practice Address - Country:US
Practice Address - Phone:206-497-0470
Practice Address - Fax:206-497-0468
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA212387101Medicaid
WA182507252OtherIPN