Provider Demographics
NPI:1134723992
Name:TYREE, COOPER (RN BSN OCN)
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:
Last Name:TYREE
Suffix:
Gender:F
Credentials:RN BSN OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 READING RD STE 480
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1439
Mailing Address - Country:US
Mailing Address - Phone:513-305-1463
Mailing Address - Fax:
Practice Address - Street 1:2055 READING RD STE 480
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1439
Practice Address - Country:US
Practice Address - Phone:513-305-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8988OtherMEDICAL TATTOOING