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General NPI Number Information
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NPI Number | 1891176798
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Entity Type | Individual
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Provider Name | CHRISTINE COOPER
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 08/17/2025
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Provider Practice Location Address
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Address Line | 63 W WILLOWBROOK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-1656
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Country | US
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Telephone | 208-888-7877
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Fax |
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Provider Business Mailing Address
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Address Line | 3467 W MUIRFIELD DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4162
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP-1575A
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License Number State | ID
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