Healthcare Provider Details

I. General information

NPI: 1417104209
Provider Name (Legal Business Name): SANDRA COOPER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BROAD ST STE 1006
SEWICKLEY PA
15143-1500
US

IV. Provider business mailing address

PO BOX 62
WADSWORTH OH
44282-0062
US

V. Phone/Fax

Practice location:
  • Phone: 330-591-2444
  • Fax: 833-740-3510
Mailing address:
  • Phone: 330-591-2444
  • Fax: 833-740-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number024344
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN543749
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: