Provider Demographics
NPI:1790041838
Name:COOPER, TREVA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:MARIE
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:PO BOX 88361
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-0361
Mailing Address - Country:US
Mailing Address - Phone:832-393-4929
Mailing Address - Fax:832-393-5255
Practice Address - Street 1:8000 N STADIUM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1823
Practice Address - Country:US
Practice Address - Phone:832-393-4929
Practice Address - Fax:832-393-5255
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653901163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator