Provider Demographics
NPI:1912340464
Name:COOPER, DECONTEE G
Entity Type:Individual
Prefix:
First Name:DECONTEE
Middle Name:G
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3924
Mailing Address - Country:US
Mailing Address - Phone:614-425-7943
Mailing Address - Fax:
Practice Address - Street 1:2110 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3924
Practice Address - Country:US
Practice Address - Phone:614-425-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker