Provider Demographics
NPI:1275353088
Name:COOPER, LAKIESHA STACI-LEE (MPH, BIRTH DOULA)
Entity type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:STACI-LEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MPH, BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 E PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2811
Mailing Address - Country:US
Mailing Address - Phone:602-456-9329
Mailing Address - Fax:
Practice Address - Street 1:744 E PEPPER DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2811
Practice Address - Country:US
Practice Address - Phone:602-456-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula