Healthcare Provider Details

I. General information

NPI: 1073467346
Provider Name (Legal Business Name): JEAN COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 8TH AVE APT 3
MONROE WI
53566-3207
US

IV. Provider business mailing address

9726 WATTS RD APT 303
VERONA WI
53593-8219
US

V. Phone/Fax

Practice location:
  • Phone: 608-291-3623
  • Fax:
Mailing address:
  • Phone: 608-291-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1103208-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: