=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386166999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN COOPER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2017
-----------------------------------------------------
Last Update Date | 07/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 WEST 6TH AVENUE
-----------------------------------------------------
City | AFTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83110-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-248-3952
-----------------------------------------------------
Fax | 307-885-7584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1176
-----------------------------------------------------
City | AFTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83110-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-248-3952
-----------------------------------------------------
Fax | 307-885-7584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 21088
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------