Individual
JESSICA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1915 LAKE AVE, PLYMOUTH, IN 46563-9366
(574) 523-3160
Mailing address
PO BOX 1241, SOUTH BEND, IN 46624-1241
(855) 691-9888
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28192442A
IN
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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