Provider Demographics
NPI:1659647378
Name:COOPER, DESSA M (CPM, LM)
Entity type:Individual
Prefix:
First Name:DESSA
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MISSION LN LOT 6
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-4097
Mailing Address - Country:US
Mailing Address - Phone:928-940-4136
Mailing Address - Fax:
Practice Address - Street 1:924 MISSION LN LOT 6
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4097
Practice Address - Country:US
Practice Address - Phone:928-940-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife