Individual
MS. AMANDA NICOLE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
N112W15415 MEQUON RD, GERMANTOWN, WI 53022-3410
(262) 255-2112
(262) 255-6533
Mailing address
788 N JEFFERSON ST, SUITE 300/ATTN. KAAREN BUTZEN, MILWAUKEE, WI 53202-3718
(414) 272-8950
(414) 225-2929
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
63620
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588808562
—
WI
Enumeration date
04/22/2009
Last updated
11/07/2016
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