Healthcare Provider Details

I. General information

NPI: 1215000286
Provider Name (Legal Business Name): PAULA JEAN COOPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD STE 1885
OGDEN UT
84403-3195
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-4870
  • Fax: 801-475-1621
Mailing address:
  • Phone: 801-387-4870
  • Fax: 801-475-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number8145615-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberX080126
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: