Healthcare Provider Details

I. General information

NPI: 1629335906
Provider Name (Legal Business Name): JACQUELINE HALL COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL ST SUITE 300
CAMDEN NJ
08103-1539
US

IV. Provider business mailing address

14 RITTENHOUSE SQ
SICKLERVILLE NJ
08081-4047
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-9811
  • Fax:
Mailing address:
  • Phone: 856-287-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012024
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ0036900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: