Provider Demographics
NPI:1902987761
Name:COOPER, OLIVIA (RN,CNS)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2906
Mailing Address - Country:US
Mailing Address - Phone:504-201-7893
Mailing Address - Fax:504-365-3906
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1262
Practice Address - Country:US
Practice Address - Phone:504-201-7893
Practice Address - Fax:504-365-3906
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN048731 AP02395364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA180006OtherVA DESCRIBER