Provider Demographics
NPI:1356384812
Name:COOPER, JANICE LYNN (NP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1440 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1878
Practice Address - Country:US
Practice Address - Phone:231-672-2008
Practice Address - Fax:231-672-2009
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI118402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2829001Medicaid
MI500876463OtherBCBSM
MIP15090007Medicare PIN
MI500876463OtherBCBSM
MI0N16130Medicare PIN