MEDICARE: TINA COOPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide		MI

General Provider Information

NPI Number	:	1518840248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA COOPER

Provider Business Mailing Address
First Line	:	4716 CHRISTIANSEN RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-5186
Country	:	US
Telephone Number	:	517-749-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	4716 CHRISTIANSEN RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-5186
Country	:	US
Telephone Number	:	517-749-1415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “ TINA COOPER ” Practice Location

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