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General NPI Number Information
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NPI Number | 1487730214
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Entity Type | Individual
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Provider Name | JENNIE L COOPER CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1838 GREENE TREE RD SUITE 400
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City | BALTIMORE
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State | MD
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Zip | 21208-6391
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Country | US
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Telephone | 410-531-1180
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Fax | 301-854-2214
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Provider Business Mailing Address
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Address Line | 13728 SPRINGDALE DR
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1353
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Country | US
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Telephone | 410-531-1180
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Fax | 301-854-2214
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R041214
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License Number State | MD
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