Provider Demographics
NPI:1922729730
Name:COOPER, LILY BETH (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:BETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MS
Other - First Name:LILY
Other - Middle Name:BETH
Other - Last Name:MULARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:1389 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1254
Mailing Address - Country:US
Mailing Address - Phone:224-723-0339
Mailing Address - Fax:
Practice Address - Street 1:225 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1603
Practice Address - Country:US
Practice Address - Phone:224-723-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022518363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care