Healthcare Provider Details

I. General information

NPI: 1699491225
Provider Name (Legal Business Name): IMANI COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 N DREAMY DRAW DR STE 100
PHOENIX AZ
85020-4668
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 100
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-7111
  • Fax:
Mailing address:
  • Phone: 520-233-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number222873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: