Individual
MARY COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3301 BROADWAY ST, QUINCY, IL 62301-3713
(217) 277-4090
(217) 277-6778
Mailing address
3301 BROADWAY ST, QUINCY, IL 62301-3713
(217) 277-4090
(217) 277-6778
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209024241
IL
367500000X
Certified Registered Nurse Anesthetist
280593
NC
Other
Enumeration date
08/04/2017
Last updated
07/21/2022
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