Healthcare Provider Details

I. General information

NPI: 1871878462
Provider Name (Legal Business Name): JENI COOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 T STREET
SACRAMENTO CA
95811
US

IV. Provider business mailing address

1900 T STREET
SACRAMENTO CA
95811
US

V. Phone/Fax

Practice location:
  • Phone: 916-558-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: