Healthcare Provider Details

I. General information

NPI: 1174306971
Provider Name (Legal Business Name): ERIC LEE COOLEY BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 STAR GAZING LN
DURHAM NC
27703-6846
US

IV. Provider business mailing address

3617 STAR GAZING LN
DURHAM NC
27703-6846
US

V. Phone/Fax

Practice location:
  • Phone: 614-557-0738
  • Fax:
Mailing address:
  • Phone: 614-557-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001303481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: