MEDICARE: MS. WANDA S. COOPER LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	123780	TX

General Provider Information

NPI Number	:	1427258284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA S. COOPER LVN

Provider Business Mailing Address
First Line	:	PO BOX 2029
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77383-2029
Country	:	US
Telephone Number	:	713-851-8325
Fax Number	:	713-934-7028

Provider Business Practice Location Address
First Line	:	2722 STETSON LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1806
Country	:	US
Telephone Number	:	713-851-8325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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