Provider Demographics
NPI:1104140433
Name:COOPER, MARCIE DAWN (MSN, RN, AHN-BC)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:DAWN
Last Name:COOPER
Suffix:
Gender:
Credentials:MSN, RN, AHN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 S JERICHO ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5231
Mailing Address - Country:US
Mailing Address - Phone:720-333-1022
Mailing Address - Fax:
Practice Address - Street 1:5156 S JERICHO ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5231
Practice Address - Country:US
Practice Address - Phone:720-333-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
CO0192185163WC0400X
CO192185163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator