Provider Demographics
NPI:1407689896
Name:COOPER, KRISTIN DENISE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DENISE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 NODLEIGH TER
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1115
Mailing Address - Country:US
Mailing Address - Phone:612-212-5440
Mailing Address - Fax:
Practice Address - Street 1:2211 NODLEIGH TER
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1115
Practice Address - Country:US
Practice Address - Phone:612-212-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR24826163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant