Provider Demographics
NPI:1730898206
Name:COOPER, MICHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SMOKETREE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2208
Mailing Address - Country:US
Mailing Address - Phone:215-805-6499
Mailing Address - Fax:
Practice Address - Street 1:2050 DIAMOND ROCK HILL RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9529
Practice Address - Country:US
Practice Address - Phone:484-819-0411
Practice Address - Fax:484-902-0260
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026150363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology