Provider Demographics
NPI:1982798609
Name:COOPER, CLARICE LOUISE (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:CLARICE
Middle Name:LOUISE
Last Name:COOPER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:CLARICE
Other - Middle Name:LOUISE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0880
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-4091
Practice Address - Street 1:308 MISSION DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-0308
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-4091
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN22954163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health