Healthcare Provider Details

I. General information

NPI: 1568185502
Provider Name (Legal Business Name): JULIANNA COOPER DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 12TH AVE
LONGVIEW WA
98632-2509
US

IV. Provider business mailing address

156 HORSLEY PL
CASTLE ROCK WA
98611-9526
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-3892
  • Fax: 360-414-1342
Mailing address:
  • Phone: 360-751-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61386229
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61386229
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00136783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: