Individual
JACQUELYN COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 N LIND AVE, HILLSIDE, IL 60162-1538
(773) 587-0827
Mailing address
230 N LIND AVE, HILLSIDE, IL 60162-1538
(773) 587-0827
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043081911
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043081911
—
IL
Enumeration date
12/31/2019
Last updated
12/31/2019
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