Doctor Name: | MRS. MARY LYNN COOPER |
NPI Number: | 1194138586 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 1944362 |
Business Practice Address: | 8687 Sw 50th St Cooper City, FL - 333283703 |
Business Phone Number: | 9549143356 |
Business Fax Number: | |
Mailing Address: | 8687 Sw 50th St, COOPER CITY |
State: | FL |
Postal Code: | 333283703 |
Phone Number: | 9549143356 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2014 |
NPI Last Update Date: | 06/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | 1944362 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |