Healthcare Provider Details

I. General information

NPI: 1023341898
Provider Name (Legal Business Name): CHERIE L COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 TIMBERLAKE WAY STE 101
SACRAMENTO CA
95823-5412
US

IV. Provider business mailing address

8120 TIMBERLAKE WAY STE 101
SACRAMENTO CA
95823-5412
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-2124
  • Fax: 916-423-2127
Mailing address:
  • Phone: 916-423-2124
  • Fax: 916-423-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: