Healthcare Provider Details

I. General information

NPI: 1902904394
Provider Name (Legal Business Name): LORI J COOPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 E WARNER RD STE. 101
TEMPE AZ
85284-3493
US

IV. Provider business mailing address

2149 E WARNER RD STE 101
TEMPE AZ
85284-3495
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-8714
  • Fax: 480-464-0189
Mailing address:
  • Phone: 480-610-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPO254
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: