Provider Demographics
NPI:1013081306
Name:COOPER, BARENDINA YOLANDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:BARENDINA
Middle Name:YOLANDA
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SODUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14555-9613
Mailing Address - Country:US
Mailing Address - Phone:315-483-2130
Mailing Address - Fax:
Practice Address - Street 1:8326 LAKE ST
Practice Address - Street 2:
Practice Address - City:SODUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14555-9613
Practice Address - Country:US
Practice Address - Phone:315-483-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221642164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01656582Medicaid