Healthcare Provider Details

I. General information

NPI: 1275882607
Provider Name (Legal Business Name): MRS. HILARY ERIN COOPER-VANDERHORST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING PLACE
DAYTON OH
45490-2722
US

IV. Provider business mailing address

2528 ALLENBY PLACE
DAYTON OH
45449-3320
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8000
  • Fax:
Mailing address:
  • Phone: 937-974-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: