Healthcare Provider Details

I. General information

NPI: 1699498014
Provider Name (Legal Business Name): EMILY ROSE COOPER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY HANES

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 OLD YORK RD
ABINGTON PA
19001-3800
US

IV. Provider business mailing address

434 W 5TH AVE
CONSHOHOCKEN PA
19428-1670
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-1200
  • Fax:
Mailing address:
  • Phone: 267-421-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP026275
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: