Provider Demographics
NPI:1154608065
Name:COOPER, SAMANTHA ELIZABETH (NURSE AIDE)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 FALLERT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1015
Mailing Address - Country:US
Mailing Address - Phone:513-290-7265
Mailing Address - Fax:
Practice Address - Street 1:408 FALLERT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1015
Practice Address - Country:US
Practice Address - Phone:513-290-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401157171010376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide