Individual
JONAH COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(208) 336-0895
Mailing address
116 HEBERLING ST, BEAVER FALLS, PA 15010-1272
(724) 312-8407
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN750796
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
153135
PA
Other
Enumeration date
10/09/2024
Last updated
12/30/2024
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