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General NPI Number Information
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NPI Number | 1043023773
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Entity Type | Individual
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Provider Name | DESIREE COOPER-GILL RN
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Gender | Female
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | RECOVERY CENTERS OF AMERICA AT LIGHTHOUSE 5034 ATLANTIC AVENUE
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City | MAYS LANDING
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State | NJ
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Zip | 08330
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Country | US
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Telephone | 609-782-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CARLSBAD CT
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City | EGG HARBOR TWP
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State | NJ
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Zip | 08234-5877
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Country | US
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Telephone | 609-377-0129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 26NR22830800
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License Number State | NJ
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