Healthcare Provider Details

I. General information

NPI: 1851943765
Provider Name (Legal Business Name): NANCY COOPER DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E WESTVIEW CT STE B
SPOKANE WA
99218-1376
US

IV. Provider business mailing address

9135 GOLD COAST DR
SAN DIEGO CA
92126-3723
US

V. Phone/Fax

Practice location:
  • Phone: 509-626-9430
  • Fax:
Mailing address:
  • Phone: 858-218-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95017359
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61187184
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95187079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: