Healthcare Provider Details

I. General information

NPI: 1457874125
Provider Name (Legal Business Name): BARBARA COOPER MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 1210
FAYETTEVILLE GA
30214-6210
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8000
  • Fax:
Mailing address:
  • Phone: 770-315-3493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95005606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: