Individual
MRS. TYLANIA A COOPER-NNODIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRANIAL PROSTHESIS
Contact information
Practice address
73 HILLCREST LN, WILLINGBORO, NJ 08046-1235
(609) 553-4967
Mailing address
309 FELLOWSHIP RD STE 200, MOUNT LAUREL, NJ 08054-1234
(908) 793-9125
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
THEQHQ9CEC
GA
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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