Provider Demographics
NPI:1740663954
Name:COOPER, MILES WHITMAN
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:WHITMAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 NORTHWOODS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8587
Mailing Address - Country:US
Mailing Address - Phone:425-923-9780
Mailing Address - Fax:
Practice Address - Street 1:2617 NORTHWOODS LOOP RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8587
Practice Address - Country:US
Practice Address - Phone:425-923-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide