MEDICARE: IMANI COOPER RN

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	163WC1500X	Community Health Registered Nurse	222873	AZ

General Provider Information

NPI Number	:	1699491225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI COOPER RN

Provider Business Mailing Address
First Line	:	7500 N DREAMY DRAW DR STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4668
Country	:	US
Telephone Number	:	520-233-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 N DREAMY DRAW DR STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4668
Country	:	US
Telephone Number	:	520-233-7111
Fax Number	:

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

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	02/21/2023

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