Provider Demographics
NPI:1427258284
Name:COOPER, WANDA S (LVN)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:S
Last Name:COOPER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77383-2029
Mailing Address - Country:US
Mailing Address - Phone:713-851-8325
Mailing Address - Fax:713-934-7028
Practice Address - Street 1:2722 STETSON LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1806
Practice Address - Country:US
Practice Address - Phone:713-851-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123780164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse