Provider Demographics
NPI:1366047805
Name:COOPER, TOMIE SUE
Entity type:Individual
Prefix:
First Name:TOMIE
Middle Name:SUE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MOSGROVE ST APT 18
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1575
Mailing Address - Country:US
Mailing Address - Phone:937-772-7645
Mailing Address - Fax:
Practice Address - Street 1:719 MOSGROVE ST APT 18
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1575
Practice Address - Country:US
Practice Address - Phone:937-772-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker