Provider Demographics
NPI:1770537300
Name:COOPER, BRENDA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LYNN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:2351 HUDSON RD
Practice Address - Street 2:SUITE 001
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0001
Practice Address - Country:US
Practice Address - Phone:319-273-5275
Practice Address - Fax:319-273-5295
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA094763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05948OtherWELLMARK INS PLAN
421417307K7OtherJOHN DEERE HEALTH CARE
IA0480806Medicaid
IA0480806Medicaid
Q58137Medicare UPIN