Cooper, Diane Lisa

Cooper, Diane Lisa is an individual health care provider with primary practice located at 151 S University Ave # 1900 , Provo UT 84601-4427. She recently has only one registered license in Nursing Service Providers / Community Health, which is considered as her primary health care specialty. Cooper, Diane Lisa can be contacted via phone (801) 851-7033.

Contact Information

Primary practice address
151 S University Ave # 1900 Provo UT 84601-4427
Fax: (801) 343-8724
Website:

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Community Health 163WC1500X 263653-3101 Utah

Profile Details

NPI number 1861564080
LBN Legal business name Cooper, Diane Lisa
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861564080 NPPES
Utah MEDICAID 998877660009
Utah Other 55102
Utah MEDICAID PR00489
Utah Other QM0000039389
Utah Other 103003506102
Utah Other 73-00012

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