Provider Demographics
NPI:1154624617
Name:COOPER, LANA J (PA)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:J
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:107 INDUSTRIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2371
Mailing Address - Country:US
Mailing Address - Phone:919-496-2533
Mailing Address - Fax:919-496-8140
Practice Address - Street 1:107 INDUSTRIAL DR STE C
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2371
Practice Address - Country:US
Practice Address - Phone:919-496-2533
Practice Address - Fax:919-496-8140
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant