Healthcare Provider Details

I. General information

NPI: 1902472202
Provider Name (Legal Business Name): SEQUOIA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 NW 57TH ST
SEATTLE WA
98107-3018
US

IV. Provider business mailing address

1529 NW 57TH ST
SEATTLE WA
98107-3018
US

V. Phone/Fax

Practice location:
  • Phone: 903-705-8319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN60721834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: