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General NPI Number Information
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NPI Number | 1528858057
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Entity Type | Individual
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Provider Name | ABIGAIL JANE COOPER PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 801 E WASHINGTON ST STE 150
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City | MEDINA
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State | OH
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Zip | 44256-3336
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Country | US
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Telephone | 330-722-2106
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Fax | 330-764-9712
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Provider Business Mailing Address
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Address Line | 2707 STATION RD
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City | MEDINA
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State | OH
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Zip | 44256-9488
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Country | US
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Telephone | 330-416-8612
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0039123
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License Number State | OH
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