Individual
DIANE LISA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
151 S UNIVERSITY AVE # 1900, PROVO, UT 84601-4427
(801) 851-7033
(801) 343-8724
Mailing address
86 S 300 E, SPRINGVILLE, UT 84663-1424
(801) 489-6198
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
263653-3101
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103003506102
SELECT HEALTH PROVIDER #
UT
01
—
55102
PEHP PROVIDER #
UT
01
—
73-00012
UNITED HEALTHCARE #
UT
05
—
998877660009
—
UT
05
—
PR00489
—
UT
01
—
QM0000039389
ALTIUS PROVIDER #
UT
Enumeration date
11/14/2006
Last updated
07/09/2007
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