Healthcare Provider Details

I. General information

NPI: 1659909455
Provider Name (Legal Business Name): SYBIL ANN COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 THAYER TER
GWYNN OAK MD
21207-4371
US

IV. Provider business mailing address

1902 THAYER TER
GWYNN OAK MD
21207-4371
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-4781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR212869
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: