Healthcare Provider Details

I. General information

NPI: 1558134114
Provider Name (Legal Business Name): TEPINKYE COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEPINKYE JACKSON

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W 63RD ST
CHICAGO IL
60629-3317
US

IV. Provider business mailing address

7101 N CICERO AVE STE 202
LINCOLNWOOD IL
60712-2143
US

V. Phone/Fax

Practice location:
  • Phone: 773-424-8109
  • Fax:
Mailing address:
  • Phone: 847-972-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.542505
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: