Healthcare Provider Details

I. General information

NPI: 1205593779
Provider Name (Legal Business Name): JILLIAN COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN MOSBARGER RN

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 PIPPIN RD
CINCINNATI OH
45231-1202
US

IV. Provider business mailing address

1583 E US 22
MORROW OH
45152-8304
US

V. Phone/Fax

Practice location:
  • Phone: 513-924-4565
  • Fax:
Mailing address:
  • Phone: 513-582-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.432032
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN.432032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: