Individual
DIANA LACY COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
401 FIR ST, BROOKINGS, OR 97415-9222
(541) 469-3314
Mailing address
805 PARADISE LN, BROOKINGS, OR 97415-9725
(541) 251-2520
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
THW000001068
OR
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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