Healthcare Provider Details

I. General information

NPI: 1124011986
Provider Name (Legal Business Name): GLORIA R COOPER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY SUITE 100
RICHMOND VA
23235-1962
US

IV. Provider business mailing address

8700 STONY POINT PKWY SUITE 100
RICHMOND VA
23235-1962
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4500
  • Fax: 804-545-1632
Mailing address:
  • Phone: 804-775-4500
  • Fax: 804-545-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001030728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: