Provider Demographics
NPI:1902861263
Name:COOPER, CHRISTINE ROSALIE (RNNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROSALIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3444
Mailing Address - Country:US
Mailing Address - Phone:916-983-3500
Mailing Address - Fax:916-983-8437
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 2500
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-983-3500
Practice Address - Fax:916-983-8437
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18312ZMedicare ID - Type Unspecified