Individual
MRS. MARIE JEANETTE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
111 BEVER GRADE, LAPWAI, ID 83540
(208) 843-7221
Mailing address
12150 KENT AVE, OROFINO, ID 83544
(208) 476-5064
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN13277
ID
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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