Provider Demographics
NPI:1790500965
Name:COONER, JACOB (SRNA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:COONER
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4116
Mailing Address - Country:US
Mailing Address - Phone:651-263-7440
Mailing Address - Fax:
Practice Address - Street 1:MINNEAPOLIS SCHOOL OF ANESTHESIA, 700 EAST 7TH STREET
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5003
Practice Address - Country:US
Practice Address - Phone:651-263-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program