Provider Demographics
NPI:1700681764
Name:COOPER, DAVONIA S (LM)
Entity type:Individual
Prefix:
First Name:DAVONIA
Middle Name:S
Last Name:COOPER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 AVON LN APT 110
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5965
Mailing Address - Country:US
Mailing Address - Phone:954-830-7610
Mailing Address - Fax:
Practice Address - Street 1:1372 AVON LN APT 110
Practice Address - Street 2:
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5965
Practice Address - Country:US
Practice Address - Phone:954-830-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW486176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife