Provider Demographics
NPI:1194439588
Name:COOPER, CHARIS JOY (CPM, LM)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:JOY
Last Name:COOPER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MERRITT ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3398
Mailing Address - Country:US
Mailing Address - Phone:616-419-8117
Mailing Address - Fax:
Practice Address - Street 1:802 MERRITT ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3398
Practice Address - Country:US
Practice Address - Phone:616-419-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000108176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7601000108OtherLICENSED MIDWIFE