Healthcare Provider Details

I. General information

NPI: 1184553083
Provider Name (Legal Business Name): NATHANIEL JAMES COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 11TH ST NW APT A
MINOT ND
58703-2168
US

IV. Provider business mailing address

506 11TH ST NW APT A
MINOT ND
58703-2168
US

V. Phone/Fax

Practice location:
  • Phone: 701-721-0315
  • Fax:
Mailing address:
  • Phone: 701-721-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: