Healthcare Provider Details

I. General information

NPI: 1205050507
Provider Name (Legal Business Name): TRACY MICHELLE COOPER LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 24TH AVE E
SEATTLE WA
98112-3050
US

IV. Provider business mailing address

2200 24TH AVE E
SEATTLE WA
98112-3050
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-0527
  • Fax: 206-328-2310
Mailing address:
  • Phone: 206-325-0527
  • Fax: 206-328-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW0024
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: