Healthcare Provider Details

I. General information

NPI: 1730469123
Provider Name (Legal Business Name): MRS. KAREN MARLEY COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MARLEY COOPER RN

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

40 NEWPORT AVE
NEWPORT RI
02840-2147
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-1213
  • Fax:
Mailing address:
  • Phone: 910-578-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number191697
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: