Healthcare Provider Details

I. General information

NPI: 1104140433
Provider Name (Legal Business Name): MARCIE DAWN COOPER MSN, RN, AHN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5156 S JERICHO ST
CENTENNIAL CO
80015-5231
US

IV. Provider business mailing address

5156 S JERICHO ST
CENTENNIAL CO
80015-5231
US

V. Phone/Fax

Practice location:
  • Phone: 720-333-1022
  • Fax:
Mailing address:
  • Phone: 720-333-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0192185
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number192185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: