Individual
MS. SHARON COOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1694 W LOGANSPORT RD, PERU, IN 46970-3149
(765) 472-2812
Mailing address
1694 W LOGANSPORT RD, PERU, IN 46970-3149
(765) 472-2812
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000849A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001058329
ANTHEM
IN
05
—
100388440
—
IN
05
—
1008388440
—
IN
01
—
P01738512
RAILROAD MEDICARE
IN
Enumeration date
04/18/2006
Last updated
02/22/2017
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