Healthcare Provider Details

I. General information

NPI: 1609050186
Provider Name (Legal Business Name): MICHELLE R COOLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 S VERITY PKWY
MIDDLETOWN OH
45044-5513
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-869-4917
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA 17211 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: