Provider Demographics
NPI:1396437935
Name:PAUL, COOPER JOHN (FNP)
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:JOHN
Last Name:PAUL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 RIVER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4617
Mailing Address - Country:US
Mailing Address - Phone:603-440-5508
Mailing Address - Fax:
Practice Address - Street 1:255 LOW ST STE 303
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3594
Practice Address - Country:US
Practice Address - Phone:978-875-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner