Provider Demographics
NPI:1457161549
Name:COOPER, JENNIFER DIANE
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DIANE
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 1:167 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1317
Mailing Address - Country:US
Mailing Address - Phone:419-543-0722
Mailing Address - Fax:
Practice Address - Street 1:167 GIBSON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1317
Practice Address - Country:US
Practice Address - Phone:419-543-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant