Provider Demographics
NPI:1841013604
Name:COOPER, GENA YVONNE (RN)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:YVONNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:COOPER
Other - Last Name:AHLAWAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8458 73RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7975
Mailing Address - Country:US
Mailing Address - Phone:601-214-5867
Mailing Address - Fax:
Practice Address - Street 1:8458 73RD ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7975
Practice Address - Country:US
Practice Address - Phone:601-214-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60025924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse