Provider Demographics
NPI:1821336678
Name:COOPER, KARA DIANNE (CNA, CPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DIANNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:CNA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 N MONTICELLO AVE
Mailing Address - Street 2:2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4740
Mailing Address - Country:US
Mailing Address - Phone:708-522-5440
Mailing Address - Fax:
Practice Address - Street 1:1839 N MONTICELLO AVE
Practice Address - Street 2:2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4740
Practice Address - Country:US
Practice Address - Phone:708-522-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILK8H8K7X7246RP1900X
OH401274470711376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy