Individual
OCTAVIA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(215) 339-4343
Mailing address
5 FIR CT, SICKLERVILLE, NJ 08081-2118
(856) 228-8545
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN-322666L
PA
Other
Enumeration date
03/22/2012
Last updated
03/22/2012
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