Provider Demographics
NPI:1942256730
Name:HOOPER, ELAINE MARIAN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIAN
Last Name:HOOPER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-0843
Mailing Address - Country:US
Mailing Address - Phone:520-415-0330
Mailing Address - Fax:
Practice Address - Street 1:385 RANCH ROAD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467
Practice Address - Country:US
Practice Address - Phone:541-271-2119
Practice Address - Fax:541-271-9338
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN050550163WG0000X
AZAP6266363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ61213Medicare UPIN