Individual
DIANA BERNICE MUTH COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
205 BALFOUR DR, ARCHDALE, NC 27263-3117
(336) 431-0700
Mailing address
205 BALFOUR DR, ARCHDALE, NC 27263-3117
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5012359
NC
Other
Enumeration date
10/04/2019
Last updated
11/27/2023
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