Cooper, Dyan Renee

Cooper, Dyan Renee is an individual health care provider with primary practice located at 1 Childrens Pl Div Ped Neurological Surgery, Ste 4E, Saint Louis MO 63110-1002. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Cooper, Dyan Renee can be contacted via phone (314) 454-2810.

Contact Information

Primary practice address
1 Childrens Pl Div Ped Neurological Surgery, Ste 4E Saint Louis MO 63110-1002
Phone: (314) 454-2810
Fax: (314) 454-2816
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 2007036004 Missouri

Profile Details

NPI number 1578739124
LBN Legal business name Cooper, Dyan Renee
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2008
Last updated Apr 25th, 2024 - about 5 months 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 1578739124 NPPES
Missouri MEDICAID 425534203

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